Kivanc Yalin1,2, Amr Abdin1, Evgeny Lyan1, Noureddin Sawan1, Spyridon Liosis1, Christian Elsner1, Alexander Jobs1, Ben Brüggemann1, Jelena Koester1, Ingo Eitel1, Charlotte Eitel1, Roland Richard Tilz3. 1. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany. 2. Department of Cardiology, Faculty of Medicine, Usak University, Usak, Turkey. 3. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany. tilz6@hotmail.com.
Abstract
BACKGROUND: The second-generation cryoballoon (CB) is increasingly used for treatment of persistent atrial fibrillation (AF). Data regarding the clinical outcome and mechanism of arrhythmia recurrence following persistent AF ablation using CB is sparse. In this study, we aimed to assess the efficacy of CB and mechanisms of atrial tachyarrhythmia (ATA) recurrence in patients with persistent AF. METHODS AND RESULTS: A total of 133 patients (66 ± 10 years, 60% male) with symptomatic persistent AF, who were scheduled for PVI using the second-generation CB were enrolled. Follow-up included 24 h Holter recording at 3, 6 and 12 months. Any documented episode of ATA lasting more than 30 s was considered as a recurrent arrhythmic event. All targeted veins were isolated (100%). Phrenic nerve palsy with recovery during follow-up occurred in six patients (4.5%), no patient experienced tamponade or a cerebrovascular event. During 12.6 ± 5.4 months of follow-up, 89/133 (67%) patients were free of ATA recurrences. Multivariable analysis revealed recurrence in the blanking period (HR 11.46, 0.95 CI 3.92-33.49, p < 0.001), presence of cardiomyopathy (HR 2.75, 0.95 CI 1.09-6.96, p = 0.032) and PV abnormality (HR 3.56, 0.95 CI 1.21-10.43, p = 0.021) as predictors for late recurrence. CONCLUSION: In patients with persistent AF, second-generation cryoballoon use is associated with an excellent safety profile and favorable outcomes. Arrhythmia recurrence during the blanking period, presence of cardiomyopathy and PV abnormality were independent predictors of long-term AF recurrence.
BACKGROUND: The second-generation cryoballoon (CB) is increasingly used for treatment of persistent atrial fibrillation (AF). Data regarding the clinical outcome and mechanism of arrhythmia recurrence following persistent AF ablation using CB is sparse. In this study, we aimed to assess the efficacy of CB and mechanisms of atrial tachyarrhythmia (ATA) recurrence in patients with persistent AF. METHODS AND RESULTS: A total of 133 patients (66 ± 10 years, 60% male) with symptomatic persistent AF, who were scheduled for PVI using the second-generation CB were enrolled. Follow-up included 24 h Holter recording at 3, 6 and 12 months. Any documented episode of ATA lasting more than 30 s was considered as a recurrent arrhythmic event. All targeted veins were isolated (100%). Phrenic nerve palsy with recovery during follow-up occurred in six patients (4.5%), no patient experienced tamponade or a cerebrovascular event. During 12.6 ± 5.4 months of follow-up, 89/133 (67%) patients were free of ATA recurrences. Multivariable analysis revealed recurrence in the blanking period (HR 11.46, 0.95 CI 3.92-33.49, p < 0.001), presence of cardiomyopathy (HR 2.75, 0.95 CI 1.09-6.96, p = 0.032) and PV abnormality (HR 3.56, 0.95 CI 1.21-10.43, p = 0.021) as predictors for late recurrence. CONCLUSION: In patients with persistent AF, second-generation cryoballoon use is associated with an excellent safety profile and favorable outcomes. Arrhythmia recurrence during the blanking period, presence of cardiomyopathy and PV abnormality were independent predictors of long-term AF recurrence.
Authors: Christian-Hendrik Heeger; Verena Tscholl; Erik Wissner; Thomas Fink; Laura Rottner; Peter Wohlmuth; Barbara Bellmann; Mattias Roser; Shibu Mathew; Christian Sohns; Bruno Reißmann; Christine Lemeš; Tilman Maurer; Francesco Santoro; Johannes Riedl; Britta Goldmann; Ulf Landmesser; Feifan Ouyang; Karl-Heinz Kuck; Andreas Rillig; Andreas Metzner Journal: Heart Rhythm Date: 2017-05-08 Impact factor: 6.343
Authors: Alexander Fürnkranz; Stefano Bordignon; Boris Schmidt; Melanie Gunawardene; Britta Schulte-Hahn; Verena Urban; Frank Bode; Bernd Nowak; Julian K R Chun Journal: J Cardiovasc Electrophysiol Date: 2013-02-11
Authors: Douglas L Packer; Robert C Kowal; Kevin R Wheelan; James M Irwin; Jean Champagne; Peter G Guerra; Marc Dubuc; Vivek Reddy; Linda Nelson; Richard G Holcomb; John W Lehmann; Jeremy N Ruskin Journal: J Am Coll Cardiol Date: 2013-03-21 Impact factor: 24.094
Authors: Karl-Heinz Kuck; Josep Brugada; Alexander Fürnkranz; Andreas Metzner; Feifan Ouyang; K R Julian Chun; Arif Elvan; Thomas Arentz; Kurt Bestehorn; Stuart J Pocock; Jean-Paul Albenque; Claudio Tondo Journal: N Engl J Med Date: 2016-04-04 Impact factor: 91.245
Authors: Christian-H Heeger; Christian M Tiemeyer; Huong-Lan Phan; Roza Meyer-Saraei; Thomas Fink; Vanessa Sciacca; Spyridon Liosis; Ben Brüggemann; Niels Große; Bezhad Fahimi; Samuel Reincke; Karl-Heinz Kuck; Feifan Ouyang; Julia Vogler; Charlotte Eitel; Roland R Tilz Journal: Int J Cardiol Heart Vasc Date: 2020-07-03
Authors: Ji Hyun Lee; Gi-Byoung Nam; Tae-Hwa Go; Jongmin Hwang; Minsu Kim; You Mi Hwang; Jun Kim; Kee-Joon Choi; You-Ho Kim Journal: Medicine (Baltimore) Date: 2018-11 Impact factor: 1.889
Authors: Ermengol Vallès; Jesús Jiménez; Julio Martí-Almor; Jorge Toquero; José Miguel Ormaetxe; Alberto Barrera; Arcadio García-Alberola; José Manuel Rubio; Pablo Moriña; Carlos Grande; Maria Fé Arcocha; Rafael Peinado; Rocío Cózar; Julio Hernández; Luisa Pérez-Alvarez; Larraitz Gaztañaga; Angel Ferrero-De Loma-Osorio; Ricardo Ruiz-Granell; Roger Villuendas; Jesús Daniel Martínez-Alday Journal: J Clin Med Date: 2022-02-22 Impact factor: 4.241