Cryoballoon pulmonary-vein isolation for atrial fibrillation with heart failure: results from a single-center cohort

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are of growing prevalence and increasing mortality. Radiofrequency ablation is safe and effective for patients with AF and HF. Prognosis might be improved in patients treated. However, there is no prospective trial investigating efficacy and safety of cryoballon ablation in patients with AF and HF. Objective To prospectively compare cryoballoon ablation in patients with and without HF (defined as LVEF ≤40%) in terms of safety and efficacy. Methods Ongoing POLAR-HF trial is a prospective, investigator-initiated, single-center, non-inferiority, open-label study. We analyzed 244 consecutive patients who underwent cryoballoon ablation. Of these 217 had normal LVEF (age 68.1±9.6 years, CHA2DS2-VASc Score 2.5±1.3, 55.3% male) while 27 patients (11%) suffered from HF (age 70.4±8.6 years, CHA2DS2-VASc Score 3±1.2, 70.4% male). Follow-up was performed at 3, 6 and 12 months after ablation. Kaplan-Meier method was used to calculate 12-month event-rate estimates. Log-Rank Test to estimate hazard ratios in the primary analysis. Endpoints were: symptomatic AF relapse for efficacy and bleeding, stroke or death for safety. Results Analysis showed no difference in AF-free survival rate between patients with and without HF (81% vs. 76.3%, Log-Rank-Test P=0.81, Figure). Primary safety end point occurred in 5 patients with normal LVEF (2.3%) and none in the HF-group. No deaths were observed. Conclusion Results of POLAR-HF indicate that cryoballoon ablation is an effective ablation method for patients suffering from AF and HF. Event-Free Survival (Efficacy Endpoint) Funding Acknowledgement Type of funding source: None

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P4760New minimally invasive and tailor-made strategy for cryoballoon ablation in patients with paroxysmal atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.1136 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

T Nakano ◽

K Suenari ◽

K Suruga ◽

H Takemoto ◽

Y Hashimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Standard Procedure ◽

Rank Test ◽

Cryoballoon Ablation ◽

Freezing Time ◽

Free Survival ◽

Log Rank Test ◽

Group A ◽

Group B

Abstract Background Currently, cryoballoon ablation (CBA) has proven to be highly effective in achieving free from atrial fibrillation (AF), especially paroxysmal AF. However, the optimal freezing protocol for each patient to achieve successful pulmonary vein isolation by only CBA is still uncertain. The aim of this study was to evaluate the clinical implications of a reduction in the freezing duration (<180s) during CBA guided by the time to target temperature. Methods From November 2015 to August 2018, 286 consecutive paroxysmal AF patients undergoing CBA were enrolled. We compared 107 patients undergoing a tailor-made CBA procedure (Group A; August 2017-August 2018) to 179 patients with a standard CBA procedure (Group B; November 2015–July 2017). In Group A, the freezing duration was reduced to 150s when the temperature reached ≤−40°C within 40s. Furthermore, we reduced it to 120s when it reached ≤−50°C within 60s. In the other patients, the freezing time was 180s except for excessive freezing over −60°C and/or emergent situations while monitoring the esophageal temperature and for phrenic nerve injury as in Group B. Results The baseline clinical characteristics were similar between two groups. In Group A, 89 patients (83%) underwent CBA with a reduction in the freezing time. The rate of having reduction time in left inferior PV (LIPV) and right inferior PV (RIPV) was lower compared with left superior PV (LSPV) and right superior PV (RSPV) (respectively 17%, 29%, 56%, and 63.5%). However, for right inferior PV, in 31 patients having the reduced freezing time, none of them required touch-up ablation. Although the procedure time and frequency of touch-up ablation did not differ between the 2 groups, total freezing time for each PV was significantly shorter in Group A than Group B as shown in figure (LSPV: 164±28s vs. 216±67s; p<0.001, LIPV: 187±44s vs. 218±69s; p<0.001, RSPV: 147±31s vs. 192±51s; p<0.001, RIPV: 180±50 vs. 218±73s; p<0.001). The AF free survival rate during the follow-up period (356±167 days) was similar between the 2 groups (log-rank test, p=0.38). Furthermore, the complication rate was similar 2 groups. The freezing time for each PV Conclusion The safety and efficacy of the new tailor-made CBA strategy were non-inferior to the standard procedure. This study showed that the unnecessary freezing time could be reduced in most of paroxysmal AF patients.

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Handheld Capillary Blood Lactate Analyzer as an Accessible and Cost-Effective Prognostic Tool for the Assessment of Death and Heart Failure Occurrence during Long-Term Follow-Up

Disease Markers ◽

10.1155/2016/5965782 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Grzegorz M. Kubiak ◽

Wojciech Jacheć ◽

Celina Wojciechowska ◽

Magdalena Traczewska ◽

Agnieszka Kolaszko ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Survival Rate ◽

Capillary Blood ◽

Rank Test ◽

Free Survival ◽

Log Rank Test ◽

Group I ◽

Group Ii

Impact of tissue lactate accumulation on prognosis after acute myocardial infarction (AMI) is biased. The study aimed to assess the prognostic role of lactate concentration (LC) in patients with AMI during one year of follow-up. 145 consecutive patients admitted due to AMI were enrolled. The data on the frequency of endpoint occurrence (defined as I, death; II, heart failure (HF); and III, recurrent myocardial infarction (re-MI)) were collected. The patients were divided into group A (LC below the cut-off value) and group B (LC above the cut-off value) for the endpoints according to receiver operating characteristic (ROC) analysis. The cumulative survival rate was 99% in group I-A and 85% in group I-B (p = 0.0004, log-rank test). The HF-free survival rate was 95% in group II-A and 82% in group II-B (p = 0.0095, log-rank test). The re-MI-free survival rate did not differ between groups. A multivariate Cox analysis showed a statistically significant influence of LC on death [Hazard Ratio (HR): 1.41, 95% Confidence Interval (CI) (1.13–1.76), and p = 0.002] and HF [HR: 1.21, 95% CI (1.05–1.4), and p = 0.007] with no impact on re-MI occurrence. LC in capillary blood may be considered a useful prognostic marker of late-onset heart failure and death after AMI.

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Extra-pulmonary vein driver mapping and ablation for persistent atrial fibrillation in obese patients

EP Europace ◽

10.1093/europace/euaa314 ◽

2020 ◽

Author(s):

Xiaofeng Hu ◽

Weifeng Jiang ◽

Shaohui Wu ◽

Kai Xu ◽

Daoliang Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Cardiac Computed Tomography ◽

Persistent Atrial Fibrillation ◽

Posterior Wall ◽

Obese Group ◽

Rank Test ◽

Obese Patients ◽

Free Survival ◽

Log Rank Test

Abstract Aims The aim of this study was to determine whether driver ablation effectively treats persistent atrial fibrillation (AF) in obese patients. Methods and results We randomly assigned 124 persistent AF obese patients to two groups, one undergoing conventional ablation (n = 62) and the other undergoing driver ablation (n = 62). Sixty-two non-obese patients with persistent AF undergoing driver ablation served as matched controls. Bipolar electrogram dispersion was analysed for driver mapping. Epicardial adipose tissue (EAT) volume was measured using cardiac computed tomography. Obese patients had a higher proportion of driver regions in the posterior wall (56.5% vs. 32.3%, P = 0.007). Driver complexity, measured as the average number and area of driver regions, was higher in the obese group than in the non-obese group (3.5 ± 1.0 vs. 2.9 ± 0.9, P < 0.001; 15.5% ± 4.2% vs. 9.8 ± 2.6%, P < 0.001, respectively). Left atrial EAT volume correlated better with the proportion of area of driver regions than did body mass index (BMI) and total EAT (BMI: r2 = 0.250, P < 0.001; total EAT: r2 = 0.379, P < 0.001; and left atrial EAT: r2 = 0.439, P < 0.001). The rate of AF termination was significantly higher in the driver ablation group than in the conventional ablation group (82.9% vs. 22.8%, P < 0.001). During the follow-up period of 16.9 ± 6.5 months, patients in the driver ablation group had significantly better AF-free survival (91.91% vs. 79.0%, log rank test, P = 0.026) and AF/atrial tachycardia-free survival (83.9% vs. 64.5%, log rank test, P = 0.011) than did patients in the conventional ablation group. Conclusion Obesity is associated with increased driver complexity. Driver ablation improves long-term outcomes in obese patients with persistent AF.

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B-PO02-087 QUALITY OF LIFE AND HEALTHCARE UTILIZATION AFTER CRYOBALLOON ABLATION FOR TREATMENT OF ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE: REAL-WORLD RESULTS FROM THE CRYO AF GLOBAL REGISTRY

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.341 ◽

2021 ◽

Vol 18 (8) ◽

pp. S131-S132

Author(s):

Roberto Rordorf ◽

Fernando Scazzuso ◽

Julian Chun ◽

Surinder Kaur Khelae ◽

Fred Kueffer ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Atrial Fibrillation ◽

Healthcare Utilization ◽

Real World ◽

Cryoballoon Ablation ◽

Patients With Heart Failure ◽

Global Registry

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Heart failure caused by iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation

Journal of Cardiology Cases ◽

10.1016/j.jccase.2021.05.007 ◽

2021 ◽

Author(s):

Yasunobu Yamagishi ◽

Yasushi Oginosawa ◽

Kan Kikuchi ◽

Jun Muneuchi ◽

Keishiro Yagyu ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Septal Defect ◽

Cryoballoon Ablation ◽

Iatrogenic Atrial Septal Defect

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The Total Incidence of Complications and the Impact of an Anticoagulation Regime on Adverse Events After Cryoballoon Ablation of Atrial Fibrillation: A Single-Center Study of 409 Patients

Cardiovascular Therapeutics ◽

10.1111/1755-5922.12178 ◽

2016 ◽

Vol 34 (3) ◽

pp. 144-151 ◽

Cited By ~ 9

Author(s):

Buelent Koektuerk ◽

Cem H. Turan ◽

Hikmet Yorgun ◽

Kerim Keskin ◽

Moritz Schoett ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adverse Events ◽

Cryoballoon Ablation ◽

Single Center ◽

Total Incidence ◽

Single Center Study ◽

The Impact ◽

Center Study

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Abstract 16539: Heart Failure With Mid-Range or Improved Ejection Fraction Improves Cardiovascular Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.16539 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Matthew Cefalu ◽

Jasneet Devgun ◽

Samuel Kennedy ◽

Jeremy Slivnick ◽

Zachary Garrett ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Multivariable Analysis ◽

Cardiovascular Outcomes ◽

Rank Test ◽

Prior History ◽

Reduced Ejection Fraction ◽

Log Rank Test ◽

History Of ◽

The Ohio State University

Heart failure with improved ejection fraction (HFiEF) is a unique and developing clinical entity among the heart failure (HF) spectrum. Prior studies suggest the characteristics, therapy, and prognosis of HFiEF are distinctive from HF with reduced ejection fraction (HFrEF) or mid-range ejection fraction (HFmrEF). We hypothesized that patients diagnosed with acute HF who later progressed to HFiEF would have improved cardiovascular outcomes compared to HFrEF. Our retrospective study included 295 adult patients with no prior history of HF at The Ohio State University diagnosed with acute HF. We defined HFrEF as a persistent ejection fraction < 40%, HFmrEF as persistent ejection fraction 40-49%, and HFiEF as improvement from baseline ejection fraction by > 5%. Nearly 74% of patients were found to have HFiEF while 12% and 14% were classified as HFrEF and HFmrEF respectively. Using a log-rank test, the time to first cardiovascular rehospitalization was significantly longer in HFiEF compared to HFrEF or HFmrEF (p=0.0192, Figure 1). Multivariable analysis, controlled for age and gender, indicated HFiEF had a trend towards significance as an independent predictor for time to cardiovascular hospitalization (p=0.053). Notably amyloid HF, valvular HF, and ischemic HF were all significant independent predictors. Survival analysis demonstrated that HFmrEF had significantly longer survival on log-rank test compared to HFrEF (p=0.0367). Multivariable analysis shows significantly lower hazard of mortality for those with HFmrEF (HR 0.57, 95% CI [0.36-0.92], p=0.017). Our exciting data indicates the progression to HFiEF after the diagnosis of acute HF is associated with reduced cardiovascular rehospitalization, and HFmrEF is associated with increased survival. These data have implications in patient surveillance and risk stratification as well as defining the natural history of HFiEF and HFmrEF as unique entities.

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Interferon Adjuvant to Radical Nephrectomy in Robson Stages II and III Renal Cell Carcinoma: A Multicentric Randomized Study

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.2.425 ◽

2001 ◽

Vol 19 (2) ◽

pp. 425-431 ◽

Cited By ~ 195

Author(s):

Giorgio Pizzocaro ◽

Luigi Piva ◽

Maria Colavita ◽

Sonia Ferri ◽

Raffaella Artusi ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Protective Effect ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Rank Test ◽

Event Free Survival ◽

Free Survival ◽

Log Rank Test

PURPOSE: Because interferon gave promising results in the management of metastatic renal cell carcinoma in the 1980s, a multicentric randomized controlled trial was planned to compare adjuvant recombinant interferon alfa-2b (rIFNα2b) with observation after radical nephrectomy in patients with Robson stages II and III renal cell carcinoma. Overall and event-free survival were to be evaluated together with prognostic factors. PATIENTS AND METHODS: Overall and event-free survival curves for 247 patients (124 controls and 123 treated) were estimated by the Kaplan-Meier method and compared using the log-rank test. Cox’s multiple regression models were adopted to perform a joint analysis of treatment and prognostic factors. RESULTS: The 5-year overall and event-free survival probabilities were 0.665 and 0.671, respectively, for controls and 0.660 and 0.567, respectively, for the treated group; the differences were not statistically significant (2P = .861 for overall and 2P = .107 for event-free survival with the log-rank test). Regarding prognostic factors, only grade, pT, and pN demonstrated a significant prognostic role. First-order interactions of treatment with pT and pN category were investigated; a significant interaction was found between pN and treatment. A harmful effect of rIFNα2b in the 97 treated pN0 patients and a protective effect in the 13 treated pN2/pN3 patients were statistically significant. CONCLUSION: Adjuvant rIFNα2b is not indicated after radical nephrectomy for renal cell carcinoma. The protective effect in the small group of pN2/pN3 patients requires further investigation.

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Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000669 ◽

2019 ◽

Vol 29 (9) ◽

pp. 1355-1360 ◽

Cited By ~ 2

Author(s):

Giorgio Bogani ◽

Daniele Vinti ◽

Ferdinando Murgia ◽

Valentina Chiappa ◽

Umberto Leone Roberti Maggiore ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Disease Free Survival ◽

Rank Test ◽

Survival Outcomes ◽

Adjuvant Radiation ◽

Free Survival ◽

Log Rank Test ◽

Disease Free ◽

Positive Lymph Nodes

ObjectiveNodal involvement is one of the most important prognostic factors in cervical cancer patients. We aimed to assess the prognostic role in relation to the burden of nodal disease in stage IIICp cervical cancer.MethodsData on all consecutive patients diagnosed with cervical cancer undergoing primary surgery (radical hysterectomy plus lymphadenectomy) or neoadjuvant chemotherapy followed by radical hysterectomy plus lymphadenectomy, between January 1980 and December 2017, were collected in a dedicated database. Exclusion criteria were: (1) consent withdrawal; (2) synchronous malignancies (within 5 years). Survival outcomes were assessed using Kaplan-Meier and Cox models.ResultsOverall, 177 (14.1%) of 1257 patients with cervical cancer were diagnosed with positive lymph nodes. After a median follow-up of 58 (range 4–175) months, 66 (37.3%) and 37 (20.9%) patients developed recurrent disease and died of disease, respectively. Via multivariate analysis, positive para-aortic nodes (HR 2.62, 95% CI 1.12 to 6.11; p=0.025) and the number of positive nodes (HR 1.06, 95% CI 1.02 to 1.11; p=0.002) correlated with worse disease-free survival. Furthermore, the number of positive nodes (HR 1.06, 95% CI 1.01 to 1.12; p=0.021) correlated with worse overall survival. Number of positive nodes (1, 2 or ≥3) strongly correlated with both disease-free survival (p<0.001, log-rank test) and overall survival (p=0.001, log-rank test). Focusing on patients receiving adjuvant radiation and chemotherapy, the number of positive lymph nodes was associated with response to treatment (p<0.001). Median disease-free survival was 100, 42, and 12 months for patients with one, two, or three or more positive lymph node(s), respectively (p<0.001, log-rank test).ConclusionsIn stage IIICp cervical cancer, adjuvant radiation and chemotherapy provides adequate overall survival in patients diagnosed with only one metastatic node, while survival outcomes are poor in patients with two or more metastatic nodes. This highlights the need for innovative treatments in patients with a high burden of lymphatic disease.

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