Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation.

Autor: Straube F; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.; Faculty Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany., Pongratz J; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany., Kosmalla A; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany., Brueck B; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.; KardiologieErkelenz, Erkelenz, Germany., Riess L; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany., Hartl S; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.; Cardiology, University of Düsseldorf, Düsseldorf, Germany., Tesche C; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.; Faculty Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.; Department of Cardiology, Klinik Augustinum, Munich, Germany., Ebersberger U; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.; Faculty Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.; KMN-Kardiologie Muenchen Nord, Munich, Germany., Wankerl M; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany., Dorwarth U; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany., Hoffmann E; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.
Jazyk: angličtina
Zdroj: Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2021 Nov 18; Vol. 8, pp. 758408. Date of Electronic Publication: 2021 Nov 18 (Print Publication: 2021).
DOI: 10.3389/fcvm.2021.758408
Abstrakt: Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure. Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated. Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA 2 DS 2 -VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time ( p < 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure. Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.
Competing Interests: FS received honoraria for lectures from Medtronic and Bristol-Myers-Squibb outside the submitted study and educational support from Pfizer. UD reports honoraria for lectures from Medtronic Inc., outside the submitted study. SH participates in the EP fellowship from Boston Scientific, received educational support from Biotronik, Daiichi Sankyo, and honoraria for lectures from Bristol Myers Squibb outside the submitted study. EH was head of the department; the department received compensation for participation in clinical research trials outside the submitted study from Abbott, Bayer, Biotronik, Boehringer Ingelheim, Edwards, Elixier, Medtronic, and Stentys. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2021 Straube, Pongratz, Kosmalla, Brueck, Riess, Hartl, Tesche, Ebersberger, Wankerl, Dorwarth and Hoffmann.)
Databáze: MEDLINE
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