Giovanni Battista Perego1, Saverio Iacopino2, Giulio Molon3, Giuseppe Arena4, Roberto Verlato5, Paolo Pieragnoli6, Antonio Curnis7, Giuseppe Allocca8, Daniele Nicolis9, Luigi Sciarra10, Domenico Catanzariti11, Gaetano Senatore12, Giovanni Rovaris13, Francesco Brasca14, Claudio Tondo15. 1. Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca, Milano, Italy. Electronic address: perego@auxologico.it. 2. Villa Maria Cecilia, Cotignola, Italy. 3. IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy. 4. Nuovo Ospedale delle Apuane, Massa, Italy. 5. Ospedale P. Cosma, Camposampiero, Italy. 6. Ospedale Careggi, University of Florence, Italy. 7. Azienda Ospedaliera Spedali Civili, Brescia, Italy. 8. Santa Maria dei Battuti, Conegliano, Italy. 9. Azienda Ospedaliera Carlo Poma, Mantova, Italy. 10. Policlinico Casilino, Roma, Italy. 11. Santa Maria del Carmine, Rovereto, Italy. 12. Presidio Ospedaliero Riunito, Ciriè, Italy. 13. ASST San Gerardo, Monza, Italy. 14. Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca, Milano, Italy. 15. Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Pulmonary vein isolation (PVI) is an accepted strategy for paroxysmal atrial fibrillation (PAF) and persistent AF (PerAF) ablation. Limited data are available on outcomes of cryoballoon (CB) PVI in patients with structural heart disease (SHD). The purpose is to assess the clinical efficacy of a single CB-PVI procedure in patients with PAF or PerAF who also have SHD. METHODS: From April 2012, 460 AF patients with concomitant SHD underwent CB-PVI and were followed prospectively in the framework of the 1STOP ClinicalService® project. Data on procedural outcomes and long-term freedom from AF recurrence were evaluated. Out of 460 subjects, 282 patients (61%) had PAF and 178 (39%) PerAF. RESULTS: SHD patients were predominantly male (80.9%), old (62.8±8.9 years), with preserved functional capacity (New York Heart Association class >1: 39.4%), high cardioembolic risk (CHA2DS2VASc score ≥2: 69.3%), and conserved left ventricular ejection fraction (56.5±8% LVEF). Both subjects with PAF and PerAF had similar baseline clinical characteristics except for left atrial diameter (43.8±7 vs. 45.7±7mm) and area (22.9±5.2 vs. 25.1±4.4cm2), respectively. Procedure time and fluoroscopic time as well as the rate of procedural complications were not different between subjects with PAF and PerAF. After a mean follow-up of 12 months, antiarrhythmic drug therapy had dropped from 71.7% before ablation to 33.6% post-ablation (p<0.001) and the freedom from symptomatic AF recurrence was 78% for PAF and 77% for PerAF (p=0.793). Furthermore, atrial arrhythmia recurrence rate was not related to SHD. CONCLUSIONS: In a large multicenter, real-world cohort, CB-PVI was used to treat patients with PAF and PerAF who also had SHD. The arrhythmia recurrence after a single procedure was not related to either the degree of cardiac structural remodeling or the type of AF, and the rate of AF recurrence was lower than previously reported in patients with SHD in other cohort series using focal radiofrequency catheter ablation. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov (NCT01007474).
BACKGROUND: Pulmonary vein isolation (PVI) is an accepted strategy for paroxysmal atrial fibrillation (PAF) and persistent AF (PerAF) ablation. Limited data are available on outcomes of cryoballoon (CB) PVI in patients with structural heart disease (SHD). The purpose is to assess the clinical efficacy of a single CB-PVI procedure in patients with PAF or PerAF who also have SHD. METHODS: From April 2012, 460 AFpatients with concomitant SHD underwent CB-PVI and were followed prospectively in the framework of the 1STOP ClinicalService® project. Data on procedural outcomes and long-term freedom from AF recurrence were evaluated. Out of 460 subjects, 282 patients (61%) had PAF and 178 (39%) PerAF. RESULTS: SHD patients were predominantly male (80.9%), old (62.8±8.9 years), with preserved functional capacity (New York Heart Association class >1: 39.4%), high cardioembolic risk (CHA2DS2VASc score ≥2: 69.3%), and conserved left ventricular ejection fraction (56.5±8% LVEF). Both subjects with PAF and PerAF had similar baseline clinical characteristics except for left atrial diameter (43.8±7 vs. 45.7±7mm) and area (22.9±5.2 vs. 25.1±4.4cm2), respectively. Procedure time and fluoroscopic time as well as the rate of procedural complications were not different between subjects with PAF and PerAF. After a mean follow-up of 12 months, antiarrhythmic drug therapy had dropped from 71.7% before ablation to 33.6% post-ablation (p<0.001) and the freedom from symptomatic AF recurrence was 78% for PAF and 77% for PerAF (p=0.793). Furthermore, atrial arrhythmia recurrence rate was not related to SHD. CONCLUSIONS: In a large multicenter, real-world cohort, CB-PVI was used to treat patients with PAF and PerAF who also had SHD. The arrhythmia recurrence after a single procedure was not related to either the degree of cardiac structural remodeling or the type of AF, and the rate of AF recurrence was lower than previously reported in patients with SHD in other cohort series using focal radiofrequency catheter ablation. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov (NCT01007474).
Authors: Bart A Mulder; Meelad I H Al-Jazairi; Federico T Magni; Hessel F Groenveld; Robert G Tieleman; Ans C P Wiesfeld; Yong E S Tan; Isabelle C Van Gelder; Michiel Rienstra; Yuri Blaauw Journal: Open Heart Date: 2021-12