Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience

Heart Rhythm ◽  
2018 ◽  
Vol 15 (8) ◽  
pp. 1121-1129 ◽  
Author(s):  
Arash Aryana ◽  
James H. Baker ◽  
Martin A. Espinosa Ginic ◽  
Deep K. Pujara ◽  
Mark R. Bowers ◽  
...  
2020 ◽  
Vol 33 (2) ◽  
pp. 82-88
Author(s):  
Tolga Aksu ◽  
Tumer Erdem Guler ◽  
Serdar Bozyel ◽  
Kivanc Yalin

Although pulmonary vein isolation (PVI) remains the cornerstone of ablation for paroxysmal atrial fibrillation (AF), optimal ablation strategy for long-standing persistent AF (LSPAF) remains unclear. This article presents two patients with LSPAF in whom acute AF termination was achieved during ablation by using fractionated-guided extended PVI, posterior wall isolation, and mitral isthmus.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heajung L Nguyen ◽  
Carlos Macias ◽  
Houman Khakpour ◽  
Jason S Bradfield ◽  
Kalyanam Shivkumar ◽  
...  

Introduction: Catheter ablation of persistent atrial fibrillation (AF) is associated with less successful outcomes compared to paroxysmal AF. The optimal ablation strategy for persistent AF is not well established. We report our center’s experience utilizing a hybrid ablation approach of cryoballoon (CB) pulmonary vein isolation (PVI) followed by radiofrequency (RF) left atrial posterior wall isolation (LAPWI). Methods: 134 patients with persistent AF who underwent catheter ablation between 2016 and 2019 at our center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Hybrid ablation (n=62) consisted of CB PVI followed by RF roof and floor lines resulting in LAPWI. The control group (n=72) had PVI ±LAPWI with either CB (n=38) or RF (n=34). Outcomes were monitored with office visits and 7-day Holter monitors at 3, 6, 12, and 24 months post-ablation. The primary endpoint was freedom from any documented atrial tachyarrhythmia over 30 seconds. Results: Concomitant atrial flutter ablation was performed in 19/62 (31%) and 5/72 (7%) of hybrid and control cases, respectively. There was no significant difference in procedure time, however fluoroscopy time was shorter with hybrid ablation compared to control (p<.01). 18-month freedom from atrial tachyarrhythmias was 70.4% with hybrid ablation and 51.6% with PVI±LAPWI with a single energy source (p=.048). Among those with recurrence, mean AF burden was significantly lower with hybrid ablation (7%) than with a single-energy approach (60%). Conclusion: In this single center experience with multiple operators, hybrid CB-RF PVI and LAPWI reduced AF recurrence (incidence and burden) compared to PVI±LAPWI with a single energy source.


2013 ◽  
Vol 106 (10) ◽  
pp. 501-510 ◽  
Author(s):  
Frederic A. Sebag ◽  
Najia Chaachoui ◽  
Nick W. Linton ◽  
Sana Amraoui ◽  
James Harrison ◽  
...  

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