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

Abstract

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.

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

“…In the largest of these studies, 101 patients underwent PVI with a spherical cryoprobe. At last follow-up, normal sinus rhythm was seen in only 53% of patients [709]. Normal sinus rhythm without antiarrhythmic drugs was present in 25 patients.…”

“…The percent of patients who were in normal sinus rhythm at last follow-up was 76% in the two more extensive LA lesion sets, but only 29% in those patients who had PVI only. The poor efficacy of PVI alone in patients with longstanding AF and mitral valve disease has been supported by a number of other retrospective studies [708][709][710]. In the largest of these studies, 101 patients underwent PVI with a spherical cryoprobe.…”

Randomized Comparison of the Continuous vs Point-by-Point Radiofrequency Ablation of the Cavotricuspid Isthmus for Atrial Flutter

“…All patients had had effective anticoagulation for >1 month, and transesophageal echocardiography was performed to exclude any atrial thrombi before the ablation. 5 The surface electrocardiogram (ECG) and bipolar intracardiac electrograms were continuously monitored and stored on a computer-based digital recorder system. The bipolar electrograms were filtered from 30 to 500 Hz and measured at a sweep speed of 100 mm/s.…”

Surgical and minimally invasive ablation for atrial fibrillation

“…Isobe et al [53] performed pulmonary vein isolation with a spherical cryoprobe in 101 patients undergoing concomitant cardiac surgery. At last follow-up, normal sinus rhythm was only present in 53% of patients.…”