Factors Predicting Success in Cryoablation of the Pulmonary Veins in Patients With Chronic Atrial Fibrillation

Isobe, Naoki; Taniguchi, Koichi; Kono, Hiroshi; Ezure, Masahiko; Kaneko, Tatsuo; Tada, Hiroshi; Adachi, Hitoshi; Toyama, Takuji; Naito, Shigeto; Hara, Hiroshi

doi:10.1253/circj.68.999

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…The increasing size of the left atrium and the duration of AF before the operation are considered to be negative predictors of achieving and maintaining SR after surgery 19,20,30,[41][42][43][44][45][46] . In our patients too, a large preoperative left atrial diameter was a negative predicting factor.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Kolek¹,

Brát²

2010

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aim of this prospective study was to assess the presence of sinus rhythm and atrial transport function after surgical ablation of atrial fibrillation using cryoenergy, and to evaluate predictors of the success of the procedure.Methods. Between January 2005 and September 2006, 100 consecutive patients underwent left atrial cryoablation as a concomitant surgical procedure (46 patients with paroxysmal or persistent atrial fibrillation and 54 with permanent atrial fibrillation). Mitral valve surgery was performed in 74%. The mean and the median times of follow-up were 20 ± 8.5, and 24 months respectively. Atrial mechanical function was assessed by echocardiography.Results. Sinus rhythm was achieved during the postoperative follow-up in 71-81% of patients -significantly more often in the group with paroxysmal and persistent atrial fibrillation (90-98%), than patients with permanent atrial fibrillation prior to surgery (51-65%) (p<0.002). At 12 and 24 months after the surgery, a total of 68.2% and 51.2% of the patients were free from atrial fibrillation; 73.9% and 60.7% of the patients from the paroxysmal and persistent atrial fibrillation group, and 60.3% and 37.7% of patients with permanent atrial fibrillation (p=0.05). Five per cent of patients required postoperative permanent pacemaker implantation. An effective left and right atrial mechanical function was detected in 70-90%, and 96-98% of patients with sinus rhythm respectively. The following circumstances were identified as negative predictors of the presence of sinus rhythm after the ablation procedure: growing diameter of the left atrium, the duration of atrial fibrillation and the severity of mitral and tricuspid regurgitation before surgery (p<0.05). Restoration of the left atrial transport function was negatively predicted by the preoperative diameter of the left atrium, the presence of mitral valve stenosis and the severity of tricuspid regurgitation (p<0.05). A total of 95.4% of patients were free from stroke at one-year follow-up, and 94.1% at 2 years after surgery.Conclusion. Stable sinus rhythm and effective left atrial transport function are the main factors resulting in decreased morbidity after successful ablation of atrial fibrillation. A careful post-operative follow-up of the patients and individualised treatment are necessary.

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Section: Discussionmentioning

confidence: 99%

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Kolek¹,

Brát²

2010

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Several studies have reported that epicardial RF ablation or cryoablation of the PVs and/or left atrium following MVR was effective for restoration of SR in patients with MS. [27][28][29][30] Therefore, we consider that RFCA of the PVs and PTMC might become an alternative to surgical treatment. RFCA is performed worldwide in patients with AF.…”

Section: Benefits Of Rfca Following Ptmc In Patients With Msmentioning

confidence: 99%

“…13 However, recent studies demonstrate that the posterior left atrium, including the PVs, plays an important role in the genesis and maintenance of AF in patients with chronic AF. 13 In fact, cryoablation at the PV ostia, including the posterior wall of the left atrium following MVR, has demonstrated favorable outcomes in the restoration and maintenance of SR. [27][28][29][30] The Cox maze procedure with MVR or repair has been established as a surgical method for patients with MV disease and AF, and the freedom from the AF at 5 years after this combined approach is approximately 80%. 31 Therefore, although this surgical treatment is more invasive for the patient than the combined treatment of RFCA and PTMC, it might be better than RFCA and PTMC for restoring and maintaining SR in patients with MS and AF.…”

Section: Benefits Of Rfca Following Ptmc In Patients With Msmentioning

confidence: 99%

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Percutaneous Transvenous Mitral Commissurotomy and Radiofrequency Catheter Ablation in Patients With Mitral Stenosis Initial Experience and Results

Miyaji

Tada

Ito

et al. 2005

Circ J

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Background The purpose of this study was to evaluate the short-and long-term results of radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation (AF) in patients with mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC). Methods and ResultsFour patients (2 males, age 59±6 years) underwent simultaneous PTMC and pulmonary vein (PV) ablation. All patient had AF and MS (2 had persistent AF >1 month, 2 had paroxysmal AF), and the mean duration of AF was 3.4±3.3 years. The mean left atrial dimension was 47±7 mm and the mean ejection fraction was 58±4%. After PTMC, RFCA was performed in all patients (3 underwent PV isolation and 1 had PV focal ablation). The mitral valve area increased from 1.11±0.19 to 1.90±0.20 cm 2 (p<0.01). The frequency of AF episodes was dramatically reduced in the 2 patients with paroxysmal AF, and the 1 with persistent AF maintained sinus rhythm, but 1 patient with persistent AF developed recurrent AF. No complications or cardiac events occurred in any of the patients. Conclusion The combination of RFCA and PTMC was safe and feasible, and may be useful in patients with MS and AF. (Circ J 2005; 69: 1074 -1078

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“…We previously reported initial results in which 70% of patients showed sinus rhythm (SR) at discharge from the hospital. 6 Furthermore, we found that the duration of AF (AF-D), left atrial dimension (LAD), and the mean of peak left atrial appendage outflow velocities (LAA-V) before operation were important factors in assessing the likelihood of successful conversion from AF to SR. 6 In this study, the patients were followed up for a relatively long period of time to determine whether maintenance of SR was related to these variables as well as which of the variables was the best long-term predictor of SR. …”

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confidence: 99%

Left Atrial Appendage Outflow Velocity is Superior to Conventional Criteria for Predicting of Maintenance of Sinus Rhythm After Simple Cryoablation of Pulmonary Vein Orifices

Isobe

Taniguchi

Kono

et al. 2005

Circ J

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ince Haissaguerre et al reported that most atrial premature beats that initiate atrial fibrillation (AF) originate in the pulmonary veins (PV), various surgical techniques have been devised to isolated PV by incision and/or cryoablation. [1][2][3][4][5] In this context, we have used simple surgical cryoablation confined to the 4 PV orifices (PV-cryo) to eliminate chronic AF in appropriate patients undergoing cardiac surgery since 1999. We previously reported initial results in which 70% of patients showed sinus rhythm (SR) at discharge from the hospital. 6 Furthermore, we found that the duration of AF (AF-D), left atrial dimension (LAD), and the mean of peak left atrial appendage outflow velocities (LAA-V) before operation were important factors in assessing the likelihood of successful conversion from AF to SR. 6 In this study, the patients were followed up for a relatively long period of time to determine whether maintenance of SR was related to these variables as well as which of the variables was the best long-term predictor of SR. Methods PatientsWe carried out PV-cryo as part of a cardiac operation at our hospital in 101 patients with a history of chronic AF.

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Factors Predicting Success in Cryoablation of the Pulmonary Veins in Patients With Chronic Atrial Fibrillation

Cited by 6 publications

References 35 publications

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Percutaneous Transvenous Mitral Commissurotomy and Radiofrequency Catheter Ablation in Patients With Mitral Stenosis Initial Experience and Results

Left Atrial Appendage Outflow Velocity is Superior to Conventional Criteria for Predicting of Maintenance of Sinus Rhythm After Simple Cryoablation of Pulmonary Vein Orifices

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