Impact of first-line cryoablation for atrial fibrillation on healthcare utilization, arrhythmia disease burden and efficacy outcomes: real-world evidence from the Cryo Global Registry.

Autor: Zucchelli G; Second Division of Cardiology, Azienda Ospedaliero Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy. g.zucchelli@ao-pisa.toscana.it., Chun KRJ; Cardioangiologisches Centrum Bethanien, Frankfurt, Germany., Khelae SK; Institut Jantung Negara, National Heart Institute, Kuala Lumpur, Malaysia., Földesi C; Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest, Hungary., Kueffer FJ; Medtronic, Inc, Minneapolis, MN, USA., van Bragt KA; Medtronic, Inc, Minneapolis, MN, USA., Scazzuso F; Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina., On YK; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Al-Kandari F; Chest Disease Hospital, Kuwait City, Kuwait., Okumura K; Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2023 Apr; Vol. 66 (3), pp. 711-722. Date of Electronic Publication: 2022 Nov 04.
DOI: 10.1007/s10840-022-01388-6
Abstrakt: Background: Cryoballoon ablation (CBA) is an effective first-line treatment for symptomatic atrial fibrillation (AF), as recently demonstrated by three randomized trials. This sub-analysis of the Cryo Global Registry aims to examine current clinical practices of first-line CBA.
Methods: AF patients treated with first-line CBA were compared to CBA in antiarrhythmic drug (AAD)-refractory patients at 12 months. Efficacy was examined using time-to-first atrial arrhythmia recurrence following a 90-day blanking period. Healthcare utilization was evaluated by repeat ablations and hospitalizations. Disease burden was examined by assessing quality of life (QOL) and patients' reporting of symptoms.
Results: Of 1394 patients, 433 (31.1%) were treated with first-line CBA, which was more frequent in high-volume centers. Serious procedure-related adverse event rates were similar. Efficacy at 12 months was higher in the first-line group (87.8 vs. 81.6%, HR unadj 0.64 (95% CI 0.47-0.88); p < 0.01) regardless of the centers' CBA experience; when controlling for baseline characteristics, the difference was not significant (HR adj 0.87 (95% CI 0.56-1.37); p = 0.55). No difference was observed in repeat ablations and hospitalizations between cohorts. First-line patients experienced a larger mean reduction in symptoms and were prescribed AADs at a lower rate at 12-month follow-up (9.7 vs. 29.9%). QOL improved in both cohorts from baseline to 12 months with no significant difference between groups (p = 0.29).
Conclusions: In this global real-world experience, first-line CBA in patients with symptomatic AF is effective, with a larger symptom reduction compared with CBA after AAD failure and without a difference in healthcare utilization at mid-term follow-up.
Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02752737.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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