Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with sym...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Florian Straube, Janis Pongratz, Alexander Kosmalla, Benedikt Brueck, Lukas Riess, Stefan Hartl, Christian Tesche, Ullrich Ebersberger, Michael Wankerl, Uwe Dorwarth, Ellen Hoffmann
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	atrial fibrillation catheter ablation cryoballoon ablation pulmonary vein isolation persistent atrial fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/c2302b2c6e59404b80eb004582a2ad1f
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:c2302b2c6e59404b80eb004582a2ad1f
record_format	dspace
spelling	oai:doaj.org-article:c2302b2c6e59404b80eb004582a2ad1f2021-11-18T06:42:20ZCryoballoon Ablation Strategy in Persistent Atrial Fibrillation2297-055X10.3389/fcvm.2021.758408https://doaj.org/article/c2302b2c6e59404b80eb004582a2ad1f2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.758408/fullhttps://doaj.org/toc/2297-055XBackground: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated.Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA2DS2-VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time (p < 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure.Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.Florian StraubeFlorian StraubeJanis PongratzAlexander KosmallaBenedikt BrueckBenedikt BrueckLukas RiessStefan HartlStefan HartlChristian TescheChristian TescheChristian TescheUllrich EbersbergerUllrich EbersbergerUllrich EbersbergerMichael WankerlUwe DorwarthEllen HoffmannFrontiers Media S.A.articleatrial fibrillationcatheter ablationcryoballoon ablationpulmonary vein isolationpersistent atrial fibrillationDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation catheter ablation cryoballoon ablation pulmonary vein isolation persistent atrial fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation catheter ablation cryoballoon ablation pulmonary vein isolation persistent atrial fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701 Florian Straube Florian Straube Janis Pongratz Alexander Kosmalla Benedikt Brueck Benedikt Brueck Lukas Riess Stefan Hartl Stefan Hartl Christian Tesche Christian Tesche Christian Tesche Ullrich Ebersberger Ullrich Ebersberger Ullrich Ebersberger Michael Wankerl Uwe Dorwarth Ellen Hoffmann Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation
description	Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated.Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA2DS2-VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time (p < 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure.Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.
format	article
author	Florian Straube Florian Straube Janis Pongratz Alexander Kosmalla Benedikt Brueck Benedikt Brueck Lukas Riess Stefan Hartl Stefan Hartl Christian Tesche Christian Tesche Christian Tesche Ullrich Ebersberger Ullrich Ebersberger Ullrich Ebersberger Michael Wankerl Uwe Dorwarth Ellen Hoffmann
author_facet	Florian Straube Florian Straube Janis Pongratz Alexander Kosmalla Benedikt Brueck Benedikt Brueck Lukas Riess Stefan Hartl Stefan Hartl Christian Tesche Christian Tesche Christian Tesche Ullrich Ebersberger Ullrich Ebersberger Ullrich Ebersberger Michael Wankerl Uwe Dorwarth Ellen Hoffmann
author_sort	Florian Straube
title	Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation
title_short	Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation
title_full	Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation
title_fullStr	Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation
title_full_unstemmed	Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation
title_sort	cryoballoon ablation strategy in persistent atrial fibrillation
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/c2302b2c6e59404b80eb004582a2ad1f
work_keys_str_mv	AT florianstraube cryoballoonablationstrategyinpersistentatrialfibrillation AT florianstraube cryoballoonablationstrategyinpersistentatrialfibrillation AT janispongratz cryoballoonablationstrategyinpersistentatrialfibrillation AT alexanderkosmalla cryoballoonablationstrategyinpersistentatrialfibrillation AT benediktbrueck cryoballoonablationstrategyinpersistentatrialfibrillation AT benediktbrueck cryoballoonablationstrategyinpersistentatrialfibrillation AT lukasriess cryoballoonablationstrategyinpersistentatrialfibrillation AT stefanhartl cryoballoonablationstrategyinpersistentatrialfibrillation AT stefanhartl cryoballoonablationstrategyinpersistentatrialfibrillation AT christiantesche cryoballoonablationstrategyinpersistentatrialfibrillation AT christiantesche cryoballoonablationstrategyinpersistentatrialfibrillation AT christiantesche cryoballoonablationstrategyinpersistentatrialfibrillation AT ullrichebersberger cryoballoonablationstrategyinpersistentatrialfibrillation AT ullrichebersberger cryoballoonablationstrategyinpersistentatrialfibrillation AT ullrichebersberger cryoballoonablationstrategyinpersistentatrialfibrillation AT michaelwankerl cryoballoonablationstrategyinpersistentatrialfibrillation AT uwedorwarth cryoballoonablationstrategyinpersistentatrialfibrillation AT ellenhoffmann cryoballoonablationstrategyinpersistentatrialfibrillation
_version_	1718424443671281664

Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

Ejemplares similares