Arash Aryana1, James H Baker2, Martin A Espinosa Ginic2, Deep K Pujara3, Mark R Bowers4, P Gearoid O'Neill4, Kenneth A Ellenbogen5, Luigi Di Biase6, André d'Avila7, Andrea Natale8. 1. Dignity Health Heart and Vascular Institute, Mercy General Hospital, Sacramento, California. Electronic address: a_aryana@outlook.com. 2. Saint Thomas Heart, Nashville, Tennessee. 3. University of Texas School of Public Health, Houston, Texas. 4. Dignity Health Heart and Vascular Institute, Mercy General Hospital, Sacramento, California. 5. Virginia Commonwealth University Medical Center, Richmond, Virginia. 6. Albert Einstein College of Medicine, Montefiore Hospital, Bronx, New York. 7. Cardiac Arrhythmia Research Institute, Cardiac Hospital of Florianopolis, Florianopolis, Santa Catarina, Brazil. 8. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
Abstract
BACKGROUND: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). OBJECTIVE: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF). METHODS: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9%]) vs PVI alone (n = 168 [43.1%]). RESULTS: Acute isolation was achieved in 99.7% of all pulmonary veins (PVI+PWI = 99.8% vs PVI alone = 99.3%; P = .23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8% of patients to complete PVI (4 ± 2 minutes) and in 32.4% to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2% ± 6.4% vs 40.6% ± 4.9%; P < .001) and total left atrial (53.3% ± 4.2% vs 36.3% ± 3.8%; P < .001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8% vs 8.9%; P = .003) and conversion to atrial flutters (12.2% vs 5.4%; P = .02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95% confidence interval: 1.15-3.61; P = .015). CONCLUSION: PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.
BACKGROUND: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). OBJECTIVE: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF). METHODS: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9%]) vs PVI alone (n = 168 [43.1%]). RESULTS: Acute isolation was achieved in 99.7% of all pulmonary veins (PVI+PWI = 99.8% vs PVI alone = 99.3%; P = .23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8% of patients to complete PVI (4 ± 2 minutes) and in 32.4% to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2% ± 6.4% vs 40.6% ± 4.9%; P < .001) and total left atrial (53.3% ± 4.2% vs 36.3% ± 3.8%; P < .001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8% vs 8.9%; P = .003) and conversion to atrial flutters (12.2% vs 5.4%; P = .02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95% confidence interval: 1.15-3.61; P = .015). CONCLUSION:PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.
Authors: Saverio Iacopino; Gaetano Paparella; Lucio Capulzini; Erwin Ströker; Stefan Beckers; Thiago Guimarães Osório; Varnavas Varnavas; Juan Sieira; Juan Pablo Abugattas; Riccardo Maj; Francesca Salghetti; Vincent Umbrain; Muryo Terasawa; Pedro Brugada; Carlo de Asmundis; Gian Battista Chierchia Journal: J Interv Card Electrophysiol Date: 2019-04-27 Impact factor: 1.900
Authors: Julian Chun; Tilman Maurer; Andreas Rillig; Stefano Bordignon; Leon Iden; Sonia Busch; Daniel Steven; Roland R Tilz; Dong-In Shin; Heidi Estner; Felix Bourier; David Duncker; Philipp Sommer; Nils-Christian Ewertsen; Henning Jansen; Victoria Johnson; Livio Bertagnolli; Till Althoff; Andreas Metzner Journal: Herzschrittmacherther Elektrophysiol Date: 2021-11-04
Authors: Arash Aryana; Deep K Pujara; Shelley L Allen; James H Baker; Martin A Espinosa; Eric F Buch; Uma Srivatsa; Ethan Ellis; Kevin Makati; Marcin Kowalski; Sung Lee; Thomas Tadros; Tina Baykaner; Amin Al-Ahmad; André d'Avila; Luigi Di Biase; Kaoru Okishige; Andrea Natale Journal: J Interv Card Electrophysiol Date: 2020-10-03 Impact factor: 1.900
Authors: Ikechukwu Ifedili; Kristina Mouksian; David Jones; Ibrahim El Masri; Mark Heckle; John Jefferies; Yehoshua C Levine Journal: Curr Cardiol Rev Date: 2022