Jochen Michaelsen1, Ulli Parade2, Hansjörg Bauerle3, Klaus-Dieter Winter4, Ulrich Rauschenbach5, Karl Mischke6, Carl Schaefer7, Klaus-Jürgen Gutleben8, Obaida R Rana9, Tobias Willich10, Marc Schlößer11, Alfons Rötzer12, Ole A Breithardt13, Stefan Middendorf14, Rainer Grove15, Jörg Mosa16, Joachim Krug17, Guram Imnadze18, Erol Saygili19, Rainer Hoffmann20. 1. Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Wilhelmstr. 13, 49808, Lingen, Germany. 2. Department of Cardiology, Rems-Murr-Klinikum Winnenden, Winnenden, Germany. 3. Department of Cardiology, Klinikum Friedrichshafen, Friedrichshafen, Germany. 4. Department of Cardiology, Hermann-Josef-Krankenhaus Erkelenz, Erkelenz, Germany. 5. Department of Cardiology, Ev. Luth. Diakonissenanstalt Flensburg, Flensburg, Germany. 6. Department of Cardiology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany. 7. Department of Cardiology, Elbe Kliniken Stade-Buxtehude, Buxtehude, Germany. 8. Department of Cardiology, Klinikum Herford, Herford, Germany. 9. Department of Cardiology, Helios St. Marienberg-Klinik Helmstedt, Helmstedt, Germany. 10. Kardiologische Gemeinschaftspraxis Brilon, Brilon, Germany. 11. Department of Cardiology, Dreifaltigkeits-Hospital Lippstadt, Lippstadt, Germany. 12. Department of Cardiology, Medius KLINIK Ostfildern, Ostfildern, Germany. 13. Department of Cardiology, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany. 14. Department of Cardiology, Mathias-Spital Rheine, Rheine, Germany. 15. Department of Cardiology, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany. 16. Department of Cardiology, Krankenhaus Freudenstadt, Freudenstadt, Germany. 17. Department of Cardiology, Klinikum Fulda, Fulda, Germany. 18. Department of Cardiology, Klinikum Osnabrück, Osnabrück, Germany. 19. Kardio-Diabetes-Zentrum Köln, St. Antonius Krankenhaus, Cologne, Germany. 20. Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Wilhelmstr. 13, 49808, Lingen, Germany. rainer.hoffmann@hospital-lingen.de.
Abstract
BACKGROUND: The 12-month follow-up (F/U) efficacy of CBA PVI performed at community hospitals for treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF) is unknown. This study determined the 12-month efficacy of pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) performed at community hospitals with limited annual case numbers. METHODS: This registry study included 983 consecutive patients (pts) from 19 hospitals, each with an annual procedural volume of < 100 PVI procedures/year. Pts underwent CBA PVI for paroxysmal AF (n = 520), persistent AF (n = 423), or redo PVI (n = 40). The primary endpoint was frequency of documented recurrent AF, the occurrence of atrial flutter or tachycardia following a 90-day period after the index ablation and up to 12 months. The frequency of repeat ablation was determined. RESULTS: Isolation of all PVs was documented in 98% of pts at the end of the procedure. Twelve-month F/U data could be obtained in 916 pts. A 24-h ECG registration was performed in 641 pts (70.0%); in 107 pts (16.7%) of them, recurrent AF was documented. The primary endpoint was met in 193 F/U pts (21.1%). It occurred in 80/486 F/U pts with paroxysmal AF (16.4%), and in 107/390 F/U pts with persistent AF (27.4%). Redo PVI was performed in 71 pts (7.8%), and atrial flutter ablation was performed in 12 pts (1.4%). CONCLUSIONS: CBA PVI for paroxysmal or persistent AF can be performed at community hospitals with adequate rates of 12-month symptom freedom and arrhythmia recurrence. The study was registered at the German register of clinical studies (DRKS00016504).
BACKGROUND: The 12-month follow-up (F/U) efficacy of CBA PVI performed at community hospitals for treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF) is unknown. This study determined the 12-month efficacy of pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) performed at community hospitals with limited annual case numbers. METHODS: This registry study included 983 consecutive patients (pts) from 19 hospitals, each with an annual procedural volume of < 100 PVI procedures/year. Pts underwent CBA PVI for paroxysmal AF (n = 520), persistent AF (n = 423), or redo PVI (n = 40). The primary endpoint was frequency of documented recurrent AF, the occurrence of atrial flutter or tachycardia following a 90-day period after the index ablation and up to 12 months. The frequency of repeat ablation was determined. RESULTS: Isolation of all PVs was documented in 98% of pts at the end of the procedure. Twelve-month F/U data could be obtained in 916 pts. A 24-h ECG registration was performed in 641 pts (70.0%); in 107 pts (16.7%) of them, recurrent AF was documented. The primary endpoint was met in 193 F/U pts (21.1%). It occurred in 80/486 F/U pts with paroxysmal AF (16.4%), and in 107/390 F/U pts with persistent AF (27.4%). Redo PVI was performed in 71 pts (7.8%), and atrial flutter ablation was performed in 12 pts (1.4%). CONCLUSIONS: CBA PVI for paroxysmal or persistent AF can be performed at community hospitals with adequate rates of 12-month symptom freedom and arrhythmia recurrence. The study was registered at the German register of clinical studies (DRKS00016504).