Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation.

Autor: Baman JR; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Kaplan RM; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Diaz CL; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Peigh G; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Bavishi AA; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Trivedi A; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Wasserlauf J; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Chicos AB; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Arora R, Kim S; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Lin A; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Verma N; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Knight BP; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA., Passman RS; Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, 676 N St Claire Street; Suite 600, Chicago, IL, 60611, USA. r-passman@northwestern.edu.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2020 Mar; Vol. 57 (2), pp. 233-240. Date of Electronic Publication: 2019 May 17.
DOI: 10.1007/s10840-019-00560-9
Abstrakt: Purpose: Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter.
Methods: We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps.
Results: There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4% were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5%) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60%) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60% being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50% (OR 3.36, p = 0.007).
Conclusions: The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.
Databáze: MEDLINE
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