Radiofrequency or cryoballoon ablation for index pulmonary vein isolation: What is the impact on long‐term clinical outcomes after repeat ablation?

Abstract Aims The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. Methods and results In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). Conclusion Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI.

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Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: A multicenter study

Heart Rhythm ◽

10.1016/j.hrthm.2017.05.003 ◽

2017 ◽

Vol 14 (8) ◽

pp. 1111-1118 ◽

Cited By ~ 44

Author(s):

Christian-Hendrik Heeger ◽

Verena Tscholl ◽

Erik Wissner ◽

Thomas Fink ◽

Laura Rottner ◽

...

Keyword(s):

Clinical Outcomes ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Multicenter Study ◽

Second Generation ◽

Common Pulmonary Vein

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Does use of an antiarrhythmic drug prior to cryoballoon pulmonary vein isolation impact the duration of the post-ablation blanking period?

European Heart Journal ◽

10.1093/eurheartj/ehab724.0529 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Saberito ◽

N Milstein ◽

A Bhatt ◽

M Habibi ◽

T Sichrovsky ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Antiarrhythmic Drug ◽

Loop Recorder ◽

Funding Sources ◽

Long Term Follow Up ◽

The Impact ◽

First 90 Days ◽

Af Recurrence

Abstract Background At time of cryoballoon (CB) pulmonary vein isolation (PVI), some patients with atrial fibrillation (AF) are on an antiarrhythmic drug (AAD) while others are not. The impact of AAD use at time of CB PVI on the duration of post-ablation blanking period (BP) is unknown. Objective To determine whether the optimal BP duration differs between pts who were and were not taking an AAD at time of CB PVI. Methods We enrolled consecutive pts with AF who had initial CB PVI; all pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3–12 months post-PVI. Results The cohort included 165 pts (66±9 years; 99 [60%] male; 91 [55%] PAF; CHA2DS2-VASc 2.7±1.6). An AAD was being used at some point prior to ablation in 120 (73%) pts. An AAD was being used at time of CB PVI in 92 (77%) of these 120 pts; this was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n=75 [45%]); (2) last AF within 30 days of PVI (n=32 [19%]); (3) last AF within 60 days of PVI (n=17 [10%]); and (4) last AF within 90 days of PVI (n=41 [25%]). Patients not exposed to an AAD prior to CB PVI had significantly lower likelihood of having no AF in the first 90-days post ablation (p=0.004, Figure). In contrast, if AF was observed post-ablation, as time from ablation to recurrence increased, so did likelihood of long-term failure from ablation (Figure); this relationship was not impacted by use of an AAD. Conclusion The best long-term outcomes post CB PVI are seen in pts who had no prior exposure to an AAD and had no AF within the first 90 days of ablation. Subsequently, as the time from ablation to AF recurrence increased within the 90-day BP, so did likelihood of recurrent AF during long-term follow-up, irrespective of whether an AAD was or was not used. FUNDunding Acknowledgement Type of funding sources: None.

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Pulmonary vein isolation: The impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation

Heart Rhythm ◽

10.1016/j.hrthm.2013.12.025 ◽

2014 ◽

Vol 11 (4) ◽

pp. 549-556 ◽

Cited By ~ 44

Author(s):

Alex J.A. McLellan ◽

Liang-han Ling ◽

Diego Ruggiero ◽

Michael C.G. Wong ◽

Tomos E. Walters ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Venous Anatomy ◽

Term Outcome ◽

Long Term Outcome ◽

The Impact

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Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab041 ◽

2021 ◽

Author(s):

Nándor Szegedi ◽

Milán Vecsey-Nagy ◽

Judit Simon ◽

Bálint Szilveszter ◽

Szilvia Herczeg ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Anatomical Variations ◽

Effective Diameter ◽

Free Survival ◽

Female Sex ◽

The Right ◽

The Impact ◽

Af Recurrence

Abstract Aims Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique. Methods and results We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P > 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15–2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19–0.71, P = 0.003). Conclusion Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.

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Long Term Follow-up of Pulmonary Vein Isolation Using Cryoballoon Ablation

Heart Lung and Circulation ◽

10.1016/j.hlc.2015.07.012 ◽

2016 ◽

Vol 25 (3) ◽

pp. 290-295 ◽

Cited By ~ 1

Author(s):

Allan J. Davies ◽

Nick Jackson ◽

Malcolm Barlow ◽

James Leitch

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Cryoballoon Ablation ◽

Long Term Follow Up

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P1924Contact force sensing technology improves long-term clinical outcomes after a first pulmonary vein isolation procedure: a propensity score analysis

European Heart Journal ◽

10.1093/eurheartj/ehy565.p1924 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

J Mesquita ◽

D Cavaco ◽

A M Ferreira ◽

E Vaz ◽

P Carmo ◽

...

Keyword(s):

Propensity Score ◽

Clinical Outcomes ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Propensity Score Analysis ◽

Isolation Procedure ◽

Force Sensing ◽

Sensing Technology ◽

Score Analysis

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Atrial functional mitral regurgitation in patients qualified for pulmonary vein isolation: a negative prognostic factor for catheter ablation efficacy

European Heart Journal ◽

10.1093/eurheartj/ehab724.0353 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Cichon ◽

M Wybraniec ◽

M Mizia-Szubryt ◽

K Mizia-Stec

Keyword(s):

Mitral Regurgitation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Functional Mitral Regurgitation ◽

National Budget ◽

Long Term Follow Up ◽

Long Term Observation ◽

The Impact

Abstract Background Atrial functional mitral regurgitation (AF-MR) related to atrial fibrillation (AF) could affect the effectiveness of the sinus rhythm restoring procedures. Purpose The aim of the study was to evaluate the impact of AF-MR on pulmonary vein isolation (PVI) efficacy. Methods One hundred thirty-six patients (65.4% males; mean age 56±11 years) with symptomatic paroxysmal or persistent AF qualified for PVI were enrolled into the study. AF-MR assessment was performed in transthoracic (TTE) and transesophageal (TEE) echocardiography before PVI procedure. PVI efficacy was evaluated in 3-month and long-term follow-up. Results AF-MR was diagnosed in 74.3% patient in transthoracic echocardiography (TTE) (trace: 26.5%, mild: 43.4%, moderate: 3.7%, severe 0.7%) and 94.9% in transesophageal echocardiography (TEE) (trace: 17.6%, mild: 59.6%, moderate: 16.2%, severe: 1.5%). PVI 3-month efficacy was 75.7% in 3-month and 64% in the long-term observation. Severe AF-MR in TEE at baseline was associated with lower 3-month PVI efficacy (P=0.012) while moderate to severe AF MR in TEE was related to inefficient PVI assessed in long-term follow-up (P=0.041). In Kaplan- Meier analysis only moderate to severe AF-MR diagnosed in TEE had an impact on long-term procedure outcome (P=0.048). Conclusions Significant AF-MR confirmed by TEE predicts 3-month as well as long-term PVI efficacy. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The institutional budget of the First Department of Cardiology, Medical University of Silesia, Katowice, Poland

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