Hot or cold? Feasibility, safety, and outcome after radiofrequency‐guided versus cryoballoon‐guided left atrial appendage isolation

Abstract

Background: Left atrial appendage (LAA) isolation (LAAI) has been described as an adjunctive ablation strategy for patients with recurrent atrial tachyarrhythmia (ATa).Objectives: We compared the clinical impact of persistent durable LAAI between radiofrequency (RF)-guided wide-area LAAI and cryoballoon (CB)-guided ostial LAAI.Methods: Consecutive patients who underwent RF-or CB-guided LAAI were retrospectively analyzed. RF-guided LAAI was performed by combining linear ablation. CB-guided LAAI was performed by LAA ostial ablation. Following LAAI, the patients underwent an invasive remapping study. LAA closure was conducted if persistent durability was confirmed. The procedural data, LAAI durability, and ATa recurrence were assessed.Results: A total of 260 patients (RF: n = 201; CB: n = 59) undergoing LAAI were identified. The acute rate of procedural LAAI was higher in the CB group (CB:94.9% vs. RF:82.6%, p = .02) with a lower pericardial effusion incidence (CB:0% vs. RF:7.5%, p = .03). The 6-week durable LAAI was similar between the two groups (RF:78.3% vs. CB:66.0%, p = .103). During follow-up, one gastrointestinal bleeding and four stroke events including one subsequent intracranial bleeding leading to death occurred in the RF group, while one gastrointestinal bleeding occurred in the CB group.The 1-year ATa recurrence-free rate was higher in patients with durable LAAI following RF-guided LAAI (RF:76.3% vs. CB:56.7%, p = .0017). Multivariate analysis revealed RF-guided LAAI as a predictor of freedom from ATa recurrence (HR: 0.478, 95%CI: 0.336-0.823, p = .017).Conclusions: LAAI can be more readily and safely achieved by CB-guided ostial ablation. In patients with confirmed LAAI, however, the freedom from ATa recurrence was higher after RF-guided wide-area isolation.

Cryoballoon ablation of non‐PV triggers in persistent atrial fibrillation

“…In our patient cohort, transient left PNP occurred in two patients (1%), 72 and persistent left PNP in one patient 80 . Similarly, Tohoku et al 81 . reported a transient left PNP in two patients (3.4%) in their study after LAAi using CB.…”

“…Different form point‐by‐point approach using RF energy, variations in LAA ostium morphology can create hurdle for optimal engagement of CB. The acute success rate of LAAi using a CB was reported to be between 91% and 94.9% in previous studies 81,85 . In our studies, successful LAAi using a CB was achieved in 90.6%, 91.1%, and 94.4% of patients, respectively 70–72 .…”

“…The acute success rate of LAAi using a CB was reported to be between 91% and 94.9% in previous studies. 81,85 In our studies, successful LAAi using a CB was achieved in 90.6%, 91.1%, and 94.4% of patients, respectively. [70][71][72] Despite high acute isolation rates, durability of LAAi is still an important concern.…”

“…In our patient cohort, transient left PNP occurred in two patients (1%), 72 and persistent left PNP in one patient. 80 Similarly, Tohoku et al 81 reported a transient left PNP in two patients (3.4%) in their study after LAAi using CB. Therefore, it is crucial to monitor the left PN function by pacing from the left subclavian vein or using a CMC in the LAA to avoid this potential complication.…”

“…[70][71][72] Despite high acute isolation rates, durability of LAAi is still an important concern. Tohoku et al 81 reported that durable LAAi was present at 6 weeks in 66% of patients who underwent LAAi using a CB. Similarly, Bordignon et al 85 reported that durable LAAi was present in 16 of 22 patients (73%) after a median of 43 days (range 33−398).…”