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Heeger CH, Pott A, Sohns C, Riesinger L, Sommer P, Gasperetti A, Tondo C, Fassini G, Moser F, Lucas P, Weinmann K, Bohnen JE, Dahme T, Rillig A, Kuck KH, Wakili R, Metzner A, Tilz RR. Novel cryoballoon ablation system for pulmonary vein isolation: multicenter assessment of efficacy and safety-ANTARCTICA study. Europace 2022; 24:1917-1925. [PMID: 36026521 PMCID: PMC9733956 DOI: 10.1093/europace/euac148] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS Pulmonary vein isolation (PVI) either by balloon devices or radiofrequency forms the cornerstone of invasive atrial fibrillation (AF) treatment. Although equally effective cryoballoon (CB)-based PVI offers shorter procedure duration and a better safety profile. Beside the worldwide established Arctic Front Advance system, a novel CB device, POLARx, was recently introduced. This CB incorporates unique features, which may translate into improved efficacy and safety. However, multicentre assessment of periprocedural efficacy and safety is lacking up to date. METHODS AND RESULTS A total of 317 patients with paroxysmal or persistent AF were included and underwent POLARx CB-based PVI in 6 centres from Germany and Italy. Acute efficacy and safety were assessed in this prospective multicenter observational study. In 317 patients [mean age: 64 ± 12 years, 209 of 317 (66%) paroxysmal AF], a total of 1256 pulmonary veins (PVs) were identified and 1252 (99,7%) PVs were successfully isolated utilizing mainly the short tip POLARx CB (82%). The mean minimal CB temperature was -57.9 ± 7°C. Real-time PVI was registered in 72% of PVs. The rate of serious adverse events was 6.0% which was significantly reduced after a learning curve of 25 cases (9.3% vs. 3.0%, P = 0.018). The rate of recurrence-free survival after mean follow-up of 226 ± 115 days including a 90-day blanking period was 86.1%. CONCLUSION In this large multicentre assessment, the novel POLARx CB shows a promising efficacy and safety profile after a short learning curve.
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Affiliation(s)
- Christian-H Heeger
- Corresponding authors. Tel: +49 451 500 75293; fax: +49 451 500 44585. E-mail address: (C.-H.H.); Tel: +49 451 500 44511; fax: +49 451 500 44585. E-mail address: (R.R.T.)
| | | | - Christian Sohns
- Herz und Diabeteszentrum, Klinik für Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Lisa Riesinger
- Universitätsklinikum Essen, Westdeutsches Herz- und Gefäßzentrum Essen, Germany
| | - Philipp Sommer
- Herz und Diabeteszentrum, Klinik für Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Alessio Gasperetti
- Centro Cardiologico Monzino, Heart Rhythm Center at IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, Heart Rhythm Center at IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gaetano Fassini
- Centro Cardiologico Monzino, Heart Rhythm Center at IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Fabian Moser
- University heart center of Hamburg Eppendorf, Germany
| | - Philipp Lucas
- Herz und Diabeteszentrum, Klinik für Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | - Jan-Eric Bohnen
- Universitätsklinikum Essen, Westdeutsches Herz- und Gefäßzentrum Essen, Germany
| | - Tillman Dahme
- Internal Medicine II, Department of Cardiology, Ulm, Germany
| | | | - Karl-Heinz Kuck
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein (UKSH), Ratzeburger Allee 160, D-23538 Lübeck, Germany,LANS Cardio, Stephansplatz 5, 20354, Hamburg, Germany
| | - Reza Wakili
- Universitätsklinikum Essen, Westdeutsches Herz- und Gefäßzentrum Essen, Germany
| | | | - Roland R Tilz
- Corresponding authors. Tel: +49 451 500 75293; fax: +49 451 500 44585. E-mail address: (C.-H.H.); Tel: +49 451 500 44511; fax: +49 451 500 44585. E-mail address: (R.R.T.)
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Incidence of Long-Term Pulmonary Vein Reconnection after a 2-Minute Cryoballoon Freeze for Pulmonary Vein Isolation—Invasive Insights of TTI-Dependent Cryoenergy Titration. J Cardiovasc Dev Dis 2022; 9:jcdd9090284. [PMID: 36135429 PMCID: PMC9505807 DOI: 10.3390/jcdd9090284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: The optimal freeze duration in cryoballoon pulmonary vein isolation (PVI) is unknown. TTI-based titration of cryoenergy allows individualized freeze duration and has emerged as a favorable ablation strategy in PV cryoablation. In a recent study, we demonstrated that omission of a bonus freeze and reduction in freeze duration to a minimum of 2 min in the case of short TTI led to comparable arrhythmia recurrence rates. Whereas clinical outcome seems to be comparable to fixed freeze duration, evidence of long-term PV reconnection rates in patients undergoing TTI-based cryoballoon ablation is sparse. Aim of the study: To evaluate the procedural efficacy of a single 2-min freeze for PVI, we assessed PV conduction recovery after cryoballoon PVI with a TTI-guided titration of freeze duration compared to a fixed ablation protocol. Methods and Results: We included consecutive patients with atrial fibrillation (AF) recurrence undergoing a second ablation procedure after the initial cryoballoon procedure. The second AF ablation procedure was performed by the 3D-mapping system and radiofrequency ablation technique. A total of 219 patients (age: 66.2 ± 10.8 years, 53% female, paroxysmal AF: 53%) treated with the TTI-guided protocol (174 patients, 685 PV) or fixed protocol (45 patients, 179 PV) showed comparable total reconnection rates (TTI: 36.9% vs. fixed: 31.8%, p = 0.21). The PV reconnection rate was not statistically different for PVs treated with a 2-min freeze in case of short TTI, compared to longer freeze duration. Interestingly, the PV reconnection rate was lower in LIPVs treated with the fixed protocol (13% vs. 31%, p = 0.029). In the TTI group, 17 out of 127 patients (15%) had durable isolation of all PVs, whereas in 8 out of 40 patients (20%) in the fixed group, all PVs were still isolated (p = 0.31). Conclusions: overall reconnection rate was not different using a TTI-guided ablation protocol compared to a fixed ablation protocol, whereas the LIPV reconnection rate was significantly lower in patients treated with a fixed ablation protocol.
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Pott A, Teumer Y, Weinmann K, Baumhardt M, Schweizer C, Buckert D, Bothner C, Rottbauer W, Dahme T. Substrate-based ablation of atypical atrial flutter in patients with atrial cardiomyopathy. IJC HEART & VASCULATURE 2022; 40:101018. [PMID: 35495579 PMCID: PMC9043977 DOI: 10.1016/j.ijcha.2022.101018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/12/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022]
Abstract
Background Standard therapy of atypical atrial flutter (AFL) aims at deploying ablation lines between two non-conducting anatomical structures, thereby creating a line of block within the re-entry circuit. We have developed an ablation strategy, where we incorporate voltage information as a surrogate for atrial fibrosis from the electro-anatomical map (EAM) during AFL ablation procedures to create individualized, substrate-based ablation lines along the area of most pronounced low-voltage within the reentry-circuit. Objective The aim of this study was to evaluate acute procedural success and long-term outcome of a substrate-based ablation (SBA) strategy in comparison to a standard anatomically based ablation (ABA) strategy for the ablation of atypical AFL. Methods Patients that underwent ablation for AFL at our institution were included. SBA procedures were compared to ABA procedures. Endpoints were acute termination of AFL and recurrence of the index AFL or any other AFL during follow-up. Results We included 47 patients, 24 individuals (51.1%) in the SBA group and 23 patients (48.9%) in the ABA group. Most patients had signs of atrial cardiomyopathy, namely enlarged left atrial diameter (LAD) and extended amount of left atrial low-voltage areas (LVA). Termination of AFL occurred in 27 of 29 (93.1%) AFL in the SBA group and in 28 of 31 (90.3%) AFL in the ABA group (p = 0.99). Freedom from recurrence of any atypical AFL after 2.5 years was 21.5% in the ABA group compared to 48.8% in the SBA group (p = 0.047). Conclusion Substrate-based ablation is as effective as an anatomically-based ablation in the acute termination of AFL but yields better rhythm outcome with less recurrence of AFL in patients with atrial cardiomyopathy.
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Ronsoni RDM, Silvestrini TL, Saffi MAL, Leiria TLL. Impact of the left common ostium following pulmonary vein isolation in
AF
: Systematic review and meta‐analysis. J Arrhythm 2022; 38:287-298. [PMID: 35785389 PMCID: PMC9237303 DOI: 10.1002/joa3.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Pulmonary vein isolation (PVI) through catheter ablation is the basis for the treatment of atrial fibrillation (AF). The left common ostium (LCO) is a high prevalence anatomical variation and has conflicting results in the effects on the prognosis following ablation. We undertook a systematic review and meta‐analysis of studies that compared the arrhythmia recurrence rate after radiofrequency ablation or cryoablation balloon between patients with normal pattern pulmonary vein and patients with LCO. Methods and Results Results were pooled using a fixed or random effect, at the discretion of heterogeneity (>25%), in addition, we associated subgroup analysis in these cases and when clinically indicated. Fourteen non‐randomized studies totaling 3278 patients were included. In analyses using the two energies all patients: OR 1.01 (95% CI 0.84–1.23; P = .90, I2 = 67%) and excluding patients with any type of persistent AF (PeAF) and those submitted to linear atrial lesion (LAL) OR 0.80 (95% CI 0.52–1.22; P = .30, I2 = 71%). Using CRYO: all patients OR 1.34 (95% CI 1.03–1.74; P = .03, I2 = 0%). Using RF: all patients—OR 0.55 (95% CI 0.32–0.95; P = .03, I2 = 49%); excluding studies with long duration PeAF and the performance of LAL concomitant—OR 0.45 (95% CI 0.23–0.91; P = .03, I2 = 44%). Conclusion The results suggest a better prognosis in patients with LCO, submitted to PVI without additional LAL under RF energy in paroxysmal AF and short‐duration PeAF. In patients undergoing CRYO, the presence of LCO suggests a worse prognosis.
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Affiliation(s)
- Rafael de March Ronsoni
- Instituto de Ritmologia Cardíaca Joinville Brazil
- Universidade da Região de Joinville Joinville Brazil
| | | | | | - Tiago Luiz Luz Leiria
- Graduate Program in Health Sciences ‐ Instituto de Cardiologia of Rio Grande do Sul/Fundação Universitária de Cardiologia Porto Alegre Brazil
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Safety and Efficacy of Cryoballoon Ablation of Atrial Fibrillation in relation to the Patients' Age: Results from a Large Real-World Multicenter Observational Project. Cardiol Res Pract 2022; 2021:9996047. [PMID: 34992884 PMCID: PMC8727157 DOI: 10.1155/2021/9996047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background The real-world efficacy and safety of atrial fibrillation (AF) ablation in particularly young and elderly patients are still under debate. The aim of the analysis was to investigate the effect of age on the efficacy and safety of cryoballoon ablation (CBA). Methods 2,534 patients underwent pulmonary vein isolation (PVI) by way of CBA for paroxysmal or persistent drug-resistant and symptomatic AF. The population was divided into age quartiles for evaluation, including (1) <53 years, (2) ≥53 and <61 years, (3) ≥61 and <67 years, and (4) ≥67 years. Furthermore, outcomes were analyzed in patients <41 years, ≥41 and ≤74, and >74 years old. Procedural data and complications were collected, and atrial fibrillation recurrences were evaluated during follow-up. Results Procedural-related complications (4.1%) were similar in the four subgroups according to age. At the 12-month follow-up, freedom from AF recurrence was 79.2%, 77.4%, 76.8%, and 75.2% (p=0.21), respectively (with increasing age). At 24-month follow-up, similar incidences of AF recurrence were observed in the four subgroups. When the sample was arbitrarily divided into the three age groups, a higher rate of recurrence was observed in older patients with regard to long-term follow-up (freedom from AF recurrence was 71.8% and 40.9%, respectively, at 12 and 24-month follow-up). In the univariate and multivariate analysis, age did not result in a significant predictor of AF recurrence during follow-up; however, a trend toward higher AF recurrences rates in patients ≥67 years was observed. Conclusion The data demonstrated a high degree of safety during CBA across all patient ages. Procedural performance and complications were similar between different ages; AF recurrences seem to be more frequent in patients over 74 years.
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Hartl S, Dorwarth U, Pongratz J, Aurich F, Brück B, Tesche C, Ebersberger U, Wankerl M, Hoffmann E, Straube F. Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all-comer study. J Cardiovasc Electrophysiol 2021; 32:949-957. [PMID: 33644913 DOI: 10.1111/jce.14972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objective was to analyze the impact of patient age on clinical characteristics, procedural results, safety, and outcome of cryoballoon ablation (CBA) as the primary approach in the interventional treatment of symptomatic atrial fibrillation (AF). METHODS AND RESULTS The single-center prospective observational study investigated consecutive patients who underwent initial left atrial ablation for symptomatic paroxysmal (PAF) or persistent AF (persAF). Age groups (A-F) of less than 40, 40-49, 50-59, 60-69, 70-79 and more than or equal to 80 years were evaluated. Follow-up (FU) included ECG, Holter monitoring and assessment of AF-symptoms. From 2012 to 2016, a total of 786 patients (64 ± 11 years, range 21-85) underwent CBA. With advancing age, more cardiovascular comorbidities and larger LA diameter were observed, more females were included (each p < .001). PAF (57%) and persAF (43%, p = .320) were equally distributed over all age groups. Age was neither related to procedural parameters, nor to the complication rate (3.9%, p = .233). Median FU was 38 months. Two non-procedure related noncardiac deaths occurred late during FU. Freedom from arrhythmia was independent of age at 18 months (p = .210) but decreased for patients more than or equal to 70 years at 24 months (p = .02). At 36 months, freedom from arrhythmia was 66%-74% (groups A-D), 54% (E) and 49% (F), respectively (p = .002). LA diameter and persAF were independent predictors, whereas age was a dependent predictor of recurrence. CONCLUSION CBA as the primary approach in the initial ablation procedure is safe and highly effective in the young, middle aged, and elderly population. LA diameter and persAF, but not ageing, were independent predictors for arrhythmia recurrence.
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Affiliation(s)
- Stefan Hartl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Uwe Dorwarth
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Janis Pongratz
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Florian Aurich
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Benedikt Brück
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Christian Tesche
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.,Department of Internal Medicine, Cardiology, St. Johannes-Hospital, Dortmund, Germany
| | - Ullrich Ebersberger
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.,Kardiologie MVZ München Nord, Munich, Germany
| | - Michael Wankerl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
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Vincenzo G, Palma T, Massimo L, Claudia NM, Cesare Giacomo S. The impact of left common pulmonary vein on cryoballoon ablation of atrial fibrillation. A meta-analysis. Indian Pacing Electrophysiol J 2020; 20:178-183. [PMID: 32531425 PMCID: PMC7517585 DOI: 10.1016/j.ipej.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Conflicting results regarding the impact of left common pulmonary vein (LCPV) on clinical outcome of atrial fibrillation (AF) ablation with cryoballoon technology have been reported. Methods We systematically searched PubMed and Cochrane library for articles that compared the arrhythmia recurrence rate after cryoballoon ablation between patients with normal pattern PVs and patients with LCPV. Studies of first ablation for persistent and paroxysmal AF using the 28 mm Arctic Front Advance, Medtronic cryoballoon (CB-A) reporting clinical success rates at a mean follow-up of ≥12 months were included. Data were analyzed by applying a random effects model. Results A total of 5 studies with a total of 1178 patients met our predefined inclusion criteria. After a mean follow-up of 18.4 months, the overall success rate of CB-A ablation among patients with persistent and paroxysmal AF was 57%; in the LCPV group the success rate was 46% and in the normal anatomical pattern group it was 61%. No significant heterogeneity was noted among the studies (I2 = 35.8%; Q (df = 3) = 6.23 p-value = 0.18). Arrhythmia recurrence after CB-A ablation was not statistically significant between the two groups (LogOR 0.24; 95% CI [-0.16-0.63]; p-value = 0.23). No significant difference in PNI was observed between the two groups (p-value = 0.693). Conclusion The presence of LCPV does not affect the long-term outcome of paroxysmal and persistent atrial fibrillation ablation with 28 mm CB-A compared to normal left PVs pattern.
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Affiliation(s)
- Gionti Vincenzo
- Department of Cardiology, Istituto di Cura Città di Pavia, 27100, Pavia, Italy.
| | - Tartaglione Palma
- Department of Digital Transformation, Robert Bosch SPA, 20149, Milano, Italy
| | - Longobardi Massimo
- Department of Cardiology, Istituto di Cura Città di Pavia, 27100, Pavia, Italy
| | - Negro Maria Claudia
- Department of Cardiology, Istituto di Cura Città di Pavia, 27100, Pavia, Italy
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Akhtar T, Berger R, Marine JE, Daimee UA, Calkins H, Spragg D. Cryoballoon Ablation of Atrial Fibrillation in Octogenarians. Arrhythm Electrophysiol Rev 2020; 9:104-107. [PMID: 32983532 PMCID: PMC7491081 DOI: 10.15420/aer.2020.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A significant proportion of AF patients with advanced age are being treated in clinical practice. Cryoballoon ablation of AF, given its shorter procedure time and comparable efficacy to radiofrequency ablation, has rapidly become a commonly used tool for AF ablation. Data regarding the outcomes of cryoballoon ablation of AF in octogenarians are limited because of the exclusion of this age group in the previous studies. The authors report outcomes of 15 octogenarian AF patients undergoing index cryoballoon ablation at a single centre. The mean age of the included patients was 83 ± 3 years. In total, 13 patients (87%) presented with paroxysmal AF, and two (13%) had long-standing persistent AF. At 6 and 12 months of follow-up, freedom from AF was 80% and 70%, respectively. None of the patients suffered any procedure-related complications. Cryoballoon ablation appears to be a safe and effective approach for treating symptomatic AF refractory to antiarrhythmic drug therapy in octogenarian patients, based on outcomes in this cohort. These findings require further validation in prospective randomised studies with larger sample sizes.
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Affiliation(s)
- Tauseef Akhtar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Usama A Daimee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - David Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
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Chen CF, Zhong YG, Jin CL, Gao XF, Liu XH, Xu YZ. Comparing between second-generation cryoballoon vs open-irrigated radiofrequency ablation in elderly patients: Acute and long-term outcomes. Clin Cardiol 2020; 43:500-507. [PMID: 31943264 PMCID: PMC7244300 DOI: 10.1002/clc.23335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second‐generation cryoballoon (CB‐2) vs radiofrequency (RF) ablation in elderly patients (>75‐year‐old). Hypothesis CB‐2 ablation may demonstrate different outcomes compared with that using RF ablation for elderly patients with AF. Method Elderly patients with symptomatic drug‐refractory AF were included in the study. Pulmonary vein isolation was performed in all patients. Results A total of 324 elderly patients were included (RF: 176, CB‐2:148) from September 2016 to April 2019. The CB‐2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs 135.1 ± 9.9 minutes, P < .001; 53.7 ± 8.9 vs 65.1.9 ± 9.0 minutes, P < .001), but marked fluoroscopy utilization (22.1 ± 3.3 vs 18.5 ± 3.6 minutes, P < .001). Complications occurred in 3.3% (CB‐2) and 6.2% (RF) of patients with no significant different (P = .307). The length of stay after ablation was shorter, but the costs were higher in the CB‐2 group (1.94 vs 2.53 days, P < .001 and 91 132.6 ± 3723.5 vs 81 149.4 ± 6824.1 CNY, P < .001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia was lower in the CB‐2 group (14.2 vs 23.3%, P = .047), but the long‐term success rate was similar between two groups. Conclusions CB‐2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long‐term success are similar between the two groups.
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Affiliation(s)
- Chao-Feng Chen
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi-Gang Zhong
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chao-Lun Jin
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Fei Gao
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Hua Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi-Zhou Xu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Zhang J, Ren Z, Wang S, Zhang J, Yang H, Zheng Y, Meng W, Zhao D, Xu Y. Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort. J Cardiovasc Electrophysiol 2019; 30:2734-2742. [PMID: 31588616 DOI: 10.1111/jce.14220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cryoballoon ablation (CBA) results in satisfactory outcomes for drug-resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥75 years and <75 years. METHODS A total of 677 patients (<75 years, n = 550; ≥ 75 years, n = 127) with paroxysmal (n = 603) or persistent (n = 74) non-valvular drug-resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri- and post-procedural complications. RESULTS The CHA2DS2-VASc (2.6 ± 1.7 vs 4.8 ± 1.6, P < .01) and HAS-BLED (1.8 ± 0.8 vs 2.0 ± 0.8, P = .01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation success rate was comparable (99.11% younger vs 98.98% older, P = .99). After a mean follow-up time of 12.8 ± 9.6 months, the 1-year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a nonsignificant difference in the rate of freedom from AF (log-rank P = .46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio [HR] = 0.868, 95% confidence interval [CI] 0.509-1.481; P = .6046) or continuous (HR = 0.990, 95% CI, 0.968-1.012, P = .3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P = .95) and major hemorrhagic events (1.2% younger vs 0% elder, P = .25). CONCLUSIONS The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients.
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Affiliation(s)
- Jun Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongyuan Ren
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University School of Medicine, Wuhan, Hubei Province, China
| | - Jingying Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haotian Yang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yixing Zheng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weilun Meng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Nakamura R, Okishige K, Shigeta T, Nishimura T, Kurabayashi M, Yamauchi Y, Sasano T, Hirao K. Clinical comparative study regarding interrupted and uninterrupted dabigatran therapy during perioperative periods of cryoballoon ablation for paroxysmal atrial fibrillation. J Cardiol 2019; 74:150-155. [DOI: 10.1016/j.jjcc.2019.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022]
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12
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Ikenouchi T, Nitta J, Nitta G, Kato S, Iwasaki T, Murata K, Junji M, Hirao T, Kanoh M, Takamiya T, Kato N, Inamura Y, Negi K, Sato A, Yamato T, Matsumura Y, Takahashi Y, Goya M, Hirao K. Propensity-matched comparison of cryoballoon and radiofrequency ablation for atrial fibrillation in elderly patients. Heart Rhythm 2019; 16:838-845. [DOI: 10.1016/j.hrthm.2018.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 11/29/2022]
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13
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Pulmonary vein isolation in patients with a left common pulmonary vein: Comparison between second-generation cryoballoon and radiofrequency ablation. J Cardiol 2019; 73:292-298. [DOI: 10.1016/j.jjcc.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022]
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14
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A Review of the Use of Cryoballoon Ablation for the Treatment of Persistent Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Lessons learned from cryoballon pulmonary vein isolation in elderly patients - Should we go "cold for the old"? Int J Cardiol 2019; 278:149-150. [PMID: 30551906 DOI: 10.1016/j.ijcard.2018.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 11/20/2022]
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16
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Heeger CH, Bellmann B, Fink T, Bohnen JE, Wissner E, Wohlmuth P, Rottner L, Sohns C, Tilz RR, Mathew S, Reissmann B, Lemeš C, Maurer T, Lüker J, Sultan A, Plenge T, Goldmann B, Ouyang F, Kuck KH, Metzner I, Metzner A, Steven D, Rillig A. Efficacy and safety of cryoballoon ablation in the elderly: A multicenter study. Int J Cardiol 2019; 278:108-113. [DOI: 10.1016/j.ijcard.2018.09.090] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/04/2018] [Accepted: 09/24/2018] [Indexed: 12/01/2022]
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17
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Novel spiral mapping catheter facilitates observation of the time-to-pulmonary vein isolation during cryoballoon ablation. Heart Vessels 2018; 34:496-502. [PMID: 30302548 PMCID: PMC6373539 DOI: 10.1007/s00380-018-1254-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
Observation of the time-to-pulmonary vein isolation (TTI) by a spiral mapping catheter has emerged as a valuable procedural parameter in cryoballoon pulmonary vein isolation (PVI). The 1st generation spiral mapping catheter (Achieve, SMC1) has been available as an 8-polar catheter with a distal loop diameter of 15 or 20 mm. The novel spiral mapping catheter (Achieve Advance, SMC2) was designed as a true guidewire and is available, in addition to the sizes of the SMC1, as a 10-polar mapping catheter with a distal loop diameter of 25 mm. Whether these novel features of SMC2 influence procedural characteristics of Cryo-PVI in comparison to SMC1 has not been reported. In this prospective cohort study 158 patients (age 65.1 ± 12.4 years, female 39%, paroxysmal AF 60%) undergoing PVI with the 2nd generation cryoballoon were included. SMC1 was used in 57 patients (36%), whereas 101 patients (64%) underwent Cryo-PVI with the SMC2. All PVs (623/623, 100%) were isolated successfully. Mean procedure duration was 72.0 ± 18.9 min in the SMC1 group and 74.4 ± 19.1 min in the SMC2 group (p = 0.432). Mean fluoroscopy time was also not different between both study groups (SMC1 15.7 ± 6.6 min, SMC2 15.7 ± 7.3 min, p = 0.593). TTI was observed in 68.6% of pulmonary veins in the SMC1 group, whereas TTI observation rate was 82.6% in the SMC2 group (p < 0.001). Number of freezes (5.5 ± 1.5 vs. 6.5 ± 1.9; p = 0.001) and total freeze duration (14.1 ± 4.5 vs. 17.6 ± 5.6; p < 0.001) were increased in the SMC2 group. SMC2 significantly increases TTI observation rate during Cryo-PVI. Procedure duration and fluoroscopy time are similar and number of freezes and total freeze duration are increased compared to PVI with SMC1 due to decreased stability and maneuverability of SMC2.
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Safety and efficacy of cryoballoon ablation for the treatment of atrial fibrillation in elderly patients. Clin Res Cardiol 2018; 108:167-174. [DOI: 10.1007/s00392-018-1336-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
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Pott A, Kraft C, Stephan T, Petscher K, Rottbauer W, Dahme T. Time-to-isolation guided titration of freeze duration in 3rd generation short-tip cryoballoon pulmonary vein isolation – Comparable clinical outcome and shorter procedure duration. Int J Cardiol 2018; 255:80-84. [DOI: 10.1016/j.ijcard.2017.11.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022]
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Percutaneous interventions in elderly patients with atrial fibrillation: left atrial ablation and left atrial appendage occlusion. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2017; 14:541-546. [PMID: 29056953 PMCID: PMC5641640 DOI: 10.11909/j.issn.1671-5411.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abugattas JP, Iacopino S, Moran D, De Regibus V, Takarada K, Mugnai G, Ströker E, Coutiño-Moreno HE, Choudhury R, Storti C, De Greef Y, Paparella G, Brugada P, de Asmundis C, Chierchia GB. Efficacy and safety of the second generation cryoballoon ablation for the treatment of paroxysmal atrial fibrillation in patients over 75 years: a comparison with a younger cohort. Europace 2017; 19:1798-1803. [DOI: 10.1093/europace/eux023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/25/2017] [Indexed: 01/21/2023] Open
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[Ablation for atrial fibrillation in the elderly]. Herzschrittmacherther Elektrophysiol 2017; 28:39-47. [PMID: 28138764 DOI: 10.1007/s00399-017-0484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Atrial fibrillation is mainly an arrhythmia among the elderly. The current ESC guideline determines that there is no justification to deny atrial fibrillation ablation to any age group; however, the guideline does not provide specific scientific data. Thus, the goal of this article is to summarize the data on efficacy and safety of atrial fibrillation ablation among elderly people and give treatment recommendations: (1) The success of atrial fibrillation ablation is the same between elderly and younger patients. (2) In cohort studies there was a trend to higher stroke rates among elderly people. (3) Negative predictors for stroke are an age >80 years, heart failure, stroke in history, or/and CHA2DS2-VASc score ≥6.
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