Arash Aryana1, Shelley L Allen2, Deep K Pujara3, Mark R Bowers2, Padraig Gearoid O'Neill2, Yasuteru Yamauchi4, Takatoshi Shigeta4, Eleanor C Vierra2, Kaoru Okishige4, Andrea Natale5. 1. Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA. Electronic address: a_aryana@outlook.com. 2. Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA. 3. Texas School of Public Health, Houston, Texas, USA. 4. Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan. 5. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Abstract
OBJECTIVES: The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF). BACKGROUND: Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation. METHODS: The immediate and long-term outcomes in patients with P/LSP-AF randomized toPVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined. RESULTS: Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006). CONCLUSIONS: In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
RCT Entities:
OBJECTIVES: The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF). BACKGROUND: Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation. METHODS: The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined. RESULTS: Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006). CONCLUSIONS: In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
Authors: Rodrigue Garcia; Mathilde Clouard; Fabian Plank; Bruno Degand; Séverine Philibert; Gabriel Laurent; Pierre Poupin; Saliman Sakhy; Matthieu Gras; Markus Stühlinger; Nándor Szegedi; Szilvia Herczeg; Judit Simon; Harry J G M Crijns; Eloi Marijon; Luc Christiaens; Charles Guenancia Journal: Front Cardiovasc Med Date: 2022-09-26
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