Efficacy and Safety of Cryoballoon Ablation in Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction　― A Multicenter Study ―

Abstract

recommendations for HF patients with reduced LVEF (HFrEF) are deliberative because of the limited data. Recently, the CASTLE-AF study showed that RF-based catheter ablation for AF in patients with reduced LVEF was associated with lower rates of all-cause mortality and hospitalization for worsening HF. 5 Point-by-point ablation by RF often results in a favorable clinical outcome, but its complexity demands a long learning curve and relatively long procedural duration. In this context the 2nd-generation cryoballoon (CB2, Arctic Front Advance, Medtronic Inc., A trial fibrillation (AF) and heart failure (HF) often coexist and AF increases the risk of hospitalization because of decompensated HF in those patients. 1-3 Pulmonary vein isolation (PVI) is the cornerstone of invasive AF treatment. Radiofrequency (RF)-based catheter ablation for HF patients, compared with amiodarone therapy, significantly reduces recurrent AF and improves left ventricular ejection fraction (LVEF) in selected cases. 4 Although current guidelines recommend ablation therapy to maintain sinus rhythm (SR) for symptomatic AF patients,

Comparison of atrial arrhythmia recurrence after persistent atrial fibrillation ablation between patients with or without tachycardia‐induced cardiomyopathy

“…13 It is important to note however that in a recent study, cryoballoon-based PVI (persistent AF: 27%) in patients with HFrEF (SHD: 80%) was associated with comparable outcomes with those with preserved LVEF (73.1% vs 72.6%; P = .25). 28 These data further highlighted the high degree of variability in the outcome of CA in HF cohorts. It is important to note, however, that their study was associated with a number of important differences compared with our study,…”

“…More specifically, while the outcomes of CA in paroxysmal AF have been reported to be comparable between HF and non‐HF cohorts (78.7% vs 85.7%; P = .19), the presence of persistent AF was associated with poorer outcome after ablation (57.3% vs 75.8%; P < .001) after multiple procedures during 3.1 years follow‐up . It is important to note however that in a recent study, cryoballoon‐based PVI (persistent AF: 27%) in patients with HFrEF (SHD: 80%) was associated with comparable outcomes with those with preserved LVEF (73.1% vs 72.6%; P = .25) . These data further highlighted the high degree of variability in the outcome of CA in HF cohorts.…”

Second-Generation Visually Guided Laser Balloon Ablation System for Pulmonary Vein Isolation: Learning Curve, Safety and Efficacy ― The MERLIN Registry ―

“…All procedures were performed under deep sedation using midazolam, fentanyl, and propofol as earlier described. 15 One diagnostic catheter was introduced via the right femoral vein and positioned within the coronary sinus. A double transseptal puncture was performed via the right femoral vein under fluoroscopic guidance, using a modified Brockenbrough technique and an 8.5-Fr transseptal sheath.…”

Importance of Atrial Fibrillation in Heart Failure Patients With Preserved Ejection Fraction Without Coronary Artery Disease

“…5 A recent report has shown that cryoballoonbased pulmonary vein isolation in HFrEF patients was associated with clinical success equal to preserved LVEF, resultant New York Heart Association class and LVEF improvement. 6 Taking these findings and insights from the current study into consideration, aggressive rhythm control by catheter ablation might be a better solution for paroxysmal AF in HFpEF patients.…”