Maurizio Lunati1, Giuseppe Arena2, Saverio Iacopino3, Roberto Verlato4, Claudio Tondo5, Antonio Curnis6, Stefano Porcellini7, Luigi Sciarra8, Giulio Molon9, Gaetano Senatore10, Loira Leoni11, Giovanni Battista Perego12, Werner Rauhe13, Patrizia Pepi14, Maurizio Landolina15. 1. A De Gasperis' CardioCenter, ASST GOM Niguarda Milano, Piazza Ospedale Maggiore, Milan. 2. Nuovo Ospedale delle Apuane, Massa. 3. Maria Cecilia Hospital, Cotignola (RA), Cotignola. 4. ULSS 6 Euganea, Camposampiero. 5. Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS Milan. 6. Azienda Ospedaliera Spedali Civili, Brescia. 7. Clinica San Carlo, Paderno Dugnano. 8. Policlinico Casilino, Rome. 9. Ospedale Sacro Cuore Don Calabria, Negrar. 10. Presidio Ospedaliero Riunito, Ciriè. 11. Azienda Ospedaliera di Padova, Padova. 12. S. Luca, Istituto Auxologico Italiano, Milan. 13. Ospedale Civile di Bolzano. 14. Azienda Ospedaliera Carlo Poma, Mantova. 15. Ospedale Maggiore, Crema, Italy.
Abstract
AIMS: Cryoablation is an indicated therapy for the treatment of recurrent atrial fibrillation through pulmonary vein isolation; however, the optimal time between first diagnosis of atrial fibrillation and cryoablation is still unknown. We aimed to assess the clinical efficacy and safety of early versus later treatment of patients with paroxysmal atrial fibrillation by cryoablation. METHODS: Five hundred and ten patients underwent atrial fibrillation cryoablation and were prospectively followed for at least 6 months in 43 Italian cardiology centers. The population was divided into two groups according to the time since the first diagnosis of atrial fibrillation until the index cryoablation procedure. An early-treatment group had an elapsed time of 15 months or less from atrial fibrillation diagnosis until cryoablation, and the late-treatment group had an elapsed time of greater than 15 months. During the evaluation, clinical efficacy was defined as atrial fibrillation recurrence outside a landmark 90-day blanking period, and safety was defined as the reporting of all procedure-related complications. RESULTS: In the total cohort, cryoablation was performed after a median of 36 months from the point of the patient diagnosis with drug refractory symptomatic recurrent atrial fibrillation. The early-treatment group was composed of 130 (25%) patients, whereas the late-treatment group had 380 (75%) patients. Both cohorts had similar baseline clinical characteristics. Of 510 patients, 22 had a complication related to the procedure with no difference between the two groups. Multivariable analysis showed that the risk of atrial fibrillation recurrence was significantly higher in the late-treatment group (hazard ratio: 1.77; 95% confidence interval 1.00-3.13) CONCLUSION: In our multicenter observational examination, cryoablation was well tolerated and effective in the treatment of patients with drug refractory symptomatic paroxysmal atrial fibrillation. Reducing the time between diagnosis and ablation brought about a treatment that had a lower risk of atrial fibrillation recurrence with no change in safety.(Italian ClinicalService Project: NCT01007474).
AIMS: Cryoablation is an indicated therapy for the treatment of recurrent atrial fibrillation through pulmonary vein isolation; however, the optimal time between first diagnosis of atrial fibrillation and cryoablation is still unknown. We aimed to assess the clinical efficacy and safety of early versus later treatment of patients with paroxysmal atrial fibrillation by cryoablation. METHODS: Five hundred and ten patients underwent atrial fibrillation cryoablation and were prospectively followed for at least 6 months in 43 Italian cardiology centers. The population was divided into two groups according to the time since the first diagnosis of atrial fibrillation until the index cryoablation procedure. An early-treatment group had an elapsed time of 15 months or less from atrial fibrillation diagnosis until cryoablation, and the late-treatment group had an elapsed time of greater than 15 months. During the evaluation, clinical efficacy was defined as atrial fibrillation recurrence outside a landmark 90-day blanking period, and safety was defined as the reporting of all procedure-related complications. RESULTS: In the total cohort, cryoablation was performed after a median of 36 months from the point of the patient diagnosis with drug refractory symptomatic recurrent atrial fibrillation. The early-treatment group was composed of 130 (25%) patients, whereas the late-treatment group had 380 (75%) patients. Both cohorts had similar baseline clinical characteristics. Of 510 patients, 22 had a complication related to the procedure with no difference between the two groups. Multivariable analysis showed that the risk of atrial fibrillation recurrence was significantly higher in the late-treatment group (hazard ratio: 1.77; 95% confidence interval 1.00-3.13) CONCLUSION: In our multicenter observational examination, cryoablation was well tolerated and effective in the treatment of patients with drug refractory symptomatic paroxysmal atrial fibrillation. Reducing the time between diagnosis and ablation brought about a treatment that had a lower risk of atrial fibrillation recurrence with no change in safety.(Italian ClinicalService Project: NCT01007474).
Authors: Derek S Chew; Eric Black-Maier; Zak Loring; Peter A Noseworthy; Douglas L Packer; Derek V Exner; Daniel B Mark; Jonathan P Piccini Journal: Circ Arrhythm Electrophysiol Date: 2020-03-19
Authors: Malte Kuniss; Nikola Pavlovic; Vedran Velagic; Jean Sylvain Hermida; Stewart Healey; Giuseppe Arena; Nicolas Badenco; Christian Meyer; Jian Chen; Saverio Iacopino; Frédéric Anselme; Douglas L Packer; Heinz-Friedrich Pitschner; Carlo de Asmundis; Stephan Willems; Fabio Di Piazza; Daniel Becker; Gian-Battista Chierchia Journal: Europace Date: 2021-07-18 Impact factor: 5.214