Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?
Autor: | Álvarez-Ortega CA; Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain. calvarezo@gmail.com., Solórzano Guillén CR; Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain., Barrera Cordero A; Hospital Universitario Vírgen de la Victoria, Málaga, Spain., Toquero Ramos JE; Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Martínez-Alday JD; Basurto University Hospital, Bilbao, Spain.; Clínica IMQ Zorrotzaurre, Bilbao, Spain., Grande Morales CE; Hospital Universitario Son Espases, Palma, Spain., Rodríguez González A; Hospital Universitario De Canarias, Tenerife, Spain., García Alberola A; Hospital Universitario Vírgen de la Arrixaca, Murcia, Spain., Pérez Álvarez L; Complejo Hospitalario Universitario de Coruña, Spain., Ferrero de Loma Osorio Á; Hospital Universitario Clínico de Valencia, Spain.; Hospital Quiron Valencia, Valencia, Spain., Hernández Afonso JS; Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain., Cózar León R; Hospital Universitario Vírgen Macarena, Sevilla, Spain.; Hospital Vithas Sevilla, Spain., Cano Pérez Ó; Hospital Universitario La Fé, Valencia, Spain., Trucco E; Hospital Universitario Josep Trueta, Girona, Spain., Peinado Peinado R; Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain. |
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Jazyk: | angličtina |
Zdroj: | Cardiology journal [Cardiol J] 2024; Vol. 31 (2), pp. 193-204. Date of Electronic Publication: 2023 Mar 13. |
DOI: | 10.5603/CJ.a2023.0017 |
Abstrakt: | Background: Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA. Methods: A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built. Results: Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan-Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4-75.8%) in the Prior-CB, and 89.2% (95% CI 73.6-95.9%) in the Prior-RF group (p = 0.002). Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05-6.79). Conclusions: Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991. |
Databáze: | MEDLINE |
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