The efficacy and safety of cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation

Objective The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. Methods This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. Results The median duration of PAF was 24 (3–60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191–3.004; hazard ratio=0.665, 95% confidence interval: 0.134–3.300, respectively). Kaplan–Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. Conclusions FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.

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Outcome of contact force-guided radiofrequency catheter ablation or second generation cryoballoon ablation for paroxysmal atrial fibrillation: propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.0571 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Ukita ◽

A Kawamura ◽

H Nakamura ◽

K Yasumoto ◽

M Tsuda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Propensity Score ◽

Contact Force ◽

Paroxysmal Atrial Fibrillation ◽

Radiofrequency Catheter Ablation ◽

Second Generation ◽

Late Recurrence ◽

Cryoballoon Ablation ◽

Atrial Tachyarrhythmia

Abstract Background Little has been reported on the outcome of contact force (CF)-guided radiofrequency catheter ablation (RFCA) and second generation cryoballoon ablation (CBA). Purpose The purpose of this study was to compare the outcome of CF-guided RFCA and second generation CBA for paroxysmal atrial fibrillation (PAF). Methods We enrolled the consecutive 364 patients with PAF who underwent initial ablation between September 2014 and July 2018 in our hospital. We compared the late recurrence of atrial tachyarrhythmia more than three months after ablation between RFCA group and CBA group. All RFCA procedures were performed using CF-sensing catheter and all CBA procedures were performed using second generation CB. Results There were significant differences in background characteristics: chronic kidney disease, serum brain natriuretic peptide level, and left ventricular ejection fraction. After propensity score matched analysis (Table), atrial tachyarrhythmia free survival was significantly higher in CBA group than in RFCA group (Figure). Conclusions Second generation CBA showed a significantly lower late recurrence rate compared to CF-guided RFCA. Kaplan-Meier Curve Funding Acknowledgement Type of funding source: None

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A Novel Temperature-Controlled Radiofrequency Catheter Ablation System Used to Treat Patients With Paroxysmal Atrial Fibrillation

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2020.11.009 ◽

2021 ◽

Author(s):

Josef Kautzner ◽

Jean-Paul Albenque ◽

Andrea Natale ◽

William Maddox ◽

Frank Cuoco ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Radiofrequency Catheter Ablation ◽

Temperature Controlled

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Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

International Journal of Arrhythmia ◽

10.1186/s42444-019-0002-3 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Young Choi ◽

Sung-Hwan Kim ◽

Ju Youn Kim ◽

Youmi Hwang ◽

Tae-Seok Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Primary Outcome ◽

Secondary Outcome ◽

Positive Pressure ◽

Efficacy And Safety ◽

Af Ablation ◽

Hemodynamic Compromise ◽

3D Mapping System ◽

Sedative Agents

Abstract Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

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