Clinical outcomes of cryoballoon ablation for pulmonary vein isolation: Impact of intraprocedural heart rhythm

Abstract

Background: The current study sought to assess the impact of the intraprocedural heart rhythm (sinus rhythm SR vs. atrial fibrillation AF) on acute procedural characteristics, durability of pulmonary vein isolation (PVI) and long-term clinical outcomes of cryoballoon (CB) ablation. Methods: A total of 195 patients with symptomatic paroxysmal (n = 136) or persistent AF (n = 59) underwent CB-based PVI. Ablation procedures were either performed in SR (SR group; n = 147) or during AF (AF group; n = 48). Persistent AF was more frequent in the AF group than in the SR group (62% vs. 20%). All other patient baseline characteristics did not differ between the two groups. 2 Results: The nadir temperature during the CB applications was significantly lower in the AF group than in patients in the SR group (-49 interquartile range,-44;-54°C vs.-47 -42;-52°C, p = 0.002). Median procedure and fluoroscopy times as well as the rate of real-time recordings were not different between the two groups. Repeat ablation for the treatment of atrial arrhythmia recurrence was performed in 60 patients (SR: 44 30% patients; AF: 16 33% patients), with a trend towards a lower rate of PV reconnections in the AF group (p = 0.07). There was no difference in 3-year arrhythmia-free survival (p = 0.8). Conclusions: Cryoballoon-based PVI during AF results in lower nadir balloon temperatures and a trend towards a higher durability of PVI as compared to procedures performed in SR. The rate of real-time PVI recordings was not affected by the intraprocedural heart rhythm.

The impact of basic atrial rhythm during catheter ablation of atrial fibrillation on clinical outcomes: Lessons from the German Ablation Registry

“…Recently, Reissmann et al 9 published data focusing on the impact of atrial rhythm during CB‐based PVI and could confirm that the performance of CB‐based PVI during AF results in lower nadir CB temperatures and a trend towards higher durability of PVI when compared with patients ablated in SR. The significantly lower nadir CB temperature in the AF group during their study indicates that reduced atrial contractility during AF might be beneficial for balloon‐tissue contact and more effective energy transfer 9 …”

“…In general, left atrial contraction and diastolic compliance are significantly reduced during AF, which on the other hand might enhance catheter stability and more efficacious lesion creation 7 . Therefore, the index atrial rhythm might play an important role with regard to acute efficacy as well as for clinical long‐term results of AF ablation 8,9 …”

Remote proctoring for cryoballoon ablation of atrial fibrillation: A challenge or an opportunity in the COVID-19 era?

“…The patient characteristics and procedural data are presented in Table 1. All CB-based pulmonary vein isolation procedures were performed in accordance with European society of Cardiology guidelines [6], as thoroughly described previously [7,8].…”