Long-term outcomes of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation in Chinese patients

Background: It is unknown whether cryoballoon technology for persistent atrial fibrillation (AF) is a reasonable initial strategy for patients with persistent AF (perAF). Methods: 390 consecutive procedures using cryoballoon for initial AF ablation were evaluated and divided first by clinical presentation: paroxysmal AF (PAF) or perAF, and then whether PV potentials associated PV pacing (PV capture) were identified after ablation. Patients were followed for recurrent AF (median 20 months). Results: PV capture was identified in patients with PAF and perAF (PAF: 20.3% vs. perAF: 14.6%; p < 0.05). No patient charactieristic differences were identified between those patients with or without PV capture. The presence of PV capture was not associated with different outcomes in patients with PAF. However, in patients with perAF, the presence of PV capture was associated with long-term outcomes similar to patients with PAF and significantly better than patients with perAF without PV capture (p < 0.001). In patients with perAF and PV capture, a strategy of reisolation of the PVs only for recurrent AF resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with PV capture, specific electrophysiologic properties of PV tissue did not have an impact on AF recurrence. Conclusion: PV capture (and not specific PV electrophysiologic characteristics) was associated with decreased recurrent AF in patients with perAF. PV capture may identify those patients with perAF in whom PV isolation alone is sufficient at initial ablation procedure and also as the primary ablation strategy for recurrent AF.

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P1913Implantable Loop Recorder Detected Pattern of Atrial Fibrillation Recurrence Following Cryoballoon Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0660 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Musat ◽

N Milstein ◽

R Shaw ◽

A Bhatt ◽

M Preminger ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Persistent Atrial Fibrillation ◽

Limited Data ◽

Loop Recorder ◽

Long Term Follow Up ◽

Af Recurrence

Abstract Background Cryoballoon (CB) pulmonary vein isolation (PVI) is increasingly being used in patients (pts) with persistent atrial fibrillation (AF). However, there are limited data about the pattern of atrial fibrillation (AF) recurrence in these pts. Objective To assess, using an implantable loop recorder (ILR), the patterns of AF recurrence following CB PVI in pts with persistent atrial fibrillation. Methods We enrolled consecutive pts with persistent AF ablation undergoing their first CB ablation. Other cavotricuspid isthmus ablation when indicated, no other ablation was performed. A Reveal LINQ ILR (Medtronic) was implanted <3 months following ablation; all pts had a minimum of 1-year follow-up. The recurrence of any atrial arrhythmia was determined and adjudicated; 4 distinct AF patterns were characterized (Figure). Results We studied 64 pts (66±9 years; 50 [78%] male; CHA2DS2-VASc 2.6±1.9) with persistent AF; 52 (81%) pts were on an antiarrhythmic drug (AAD) peri-ablation. During 803±361 days of follow-up, 33 (52%) pts had their 1st AF recurrence 91–365 days post-ablation and another 17 (27%) pts had their 1st AF recurrence >365 days post-ablation. No AF was seen in 14 (31%) pts. Most pts (33 of 50, 66%) with AF recurrence presented with 1 of 3 distinct patterns of paroxysmal AF (Figure), which ranged from 22 min to 124 hours. In 2/3 of these pts, all AF recurrences lasted <24 hours. Only 17 (34%) pts recurred with persistent AF. Conclusion Following single CB PVI, most pts with persistent AF remained free of persistent AF during long-term follow-up. Most pts with recurrent AF have 1 of 3 distinct patterns with episodes commonly last <24 hours. These data suggest that CB PVI ablation may halt AF progression in pts initially presenting with persistent AF.

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Common ostium of the left pulmonary veins – to freeze or not to freeze – that was the question?

In a good rythm ◽

10.5604/01.3001.0010.7497 ◽

2017 ◽

Vol 4 (45) ◽

pp. 33-34

Author(s):

Michał Orczykowski

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Clinical Results ◽

Common Pulmonary Vein

Second-generation cryoballoon (CB2) - based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). Nevertheless, the acute efficacy, safety, and long-term clinical results of CB2-based PVI in patients with a left common pulmonary vein (LCPV) are still a matter of debate. Commented paper by Heeger ChH, et al. analyzes this issue with some practical conclusions.

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