Prevalence and predictive factors of left atrial tachycardia occurring after second-generation cryoballoon ablation of atrial fibrillation.

Autor: Hermida A; Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France., Kubala M; Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France., Traullé S; Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France., Buiciuc O; Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France., Quenum S; Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France., Hermida JS; Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, France.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2018 Jan; Vol. 29 (1), pp. 46-54. Date of Electronic Publication: 2017 Nov 03.
DOI: 10.1111/jce.13364
Abstrakt: Introduction: Assess the prevalence and predictors of left atrial tachycardia (LAT) after cryoballoon ablation of pulmonary veins.
Methods and Results: Patients who underwent catheter ablation of pulmonary veins with a second-generation cryoballoon for symptomatic paroxysmal (151 of 270, 56%) or persistent (119 of 270, 44%) atrial fibrillation were entered in a single-center prospective registry. Patients who experienced postcryoballoon LAT (pcryo-LAT) were selected on the basis of 12-lead ECG characteristics. Left atrial origin was confirmed during conventional EP study and electroanatomical activation mapping, and patients were treated by RF catheter ablation. Pcryo-LAT was observed in 15 (5.6%) of 270 patients and was attributed to a reentrant mechanism in 11 patients (73%). The other four cases of pcryo-LAT were due to focal atrial tachycardia associated with reconnection of one pulmonary vein. In comparison with patients who remained in sinus rhythm, LA area (HR = 1.09; CI 1.01, 1.2; P = 0.02), LVEF (HR = 0.94; CI 0.90, 0.97; P < 0.001), and LVEF <50% (HR = 8.5; CI 3.1, 23.6; P < 0.001) were predictors of pcryo-LAT. After multivariate Cox analysis, only left ventricular ejection fraction < 50% remained predictive of pcryo-LAT, (HR = 7.8, CI 2.3 26.7, P = 0.002). With a mean survival of 23 months, 73% of patients who experienced pcryo-LAT were in sinus rhythm versus 78% of patients without pcryo-LAT (log rank P = 0.85).
Conclusion: The prevalence of pcryo-LAT in patients with atrial fibrillation is low. Left ventricular ejection fraction < 50% is associated with an increased risk of pcryo-LAT. When treated by RF catheter ablation, the presence of pcryo-LAT is not a predictive factor of subsequent recurrence of atrial fibrillation during follow-up.
(© 2017 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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