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.
Keywords
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Article Info
Footnotes
This work was supported financially in part by a research grant from Medtronic.
Drs Aryana, Baker, Bowers, Di Biase, Ellenbogen, Natale, and O’Neill have received consulting fees and speaker honoraria from Medtronic. Drs Aryana, Baker, and O’Neill have received research grants from Medtronic.
Identification
Copyright
© 2018 Heart Rhythm Society. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Using the cryoballoon for posterior wall isolation: Thinking inside “the box”Heart RhythmVol. 15Issue 8
- PreviewCatheter ablation for paroxysmal atrial fibrillation (AF) is becoming increasingly common, particularly as success rates improve. In this population, pulmonary vein (PV) isolation (PVI) is the cornerstone of therapy.1,2 However, in patients with persistent AF, the optimal lesion set has not been determined. While small studies have demonstrated that additional ablation beyond PVI is associated with decreased AF recurrence, randomized data have not corroborated this notion.3–5 The combination of PVI and posterior wall isolation (PWI) is an attractive lesion set for a number of reasons.
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