Long-term outcomes of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation in Chinese patients

Chan, Ngai‐Yin; Choy, Chi-Chung; Yuen, Ho-Chuen; Chow, H.B.; Fong, Ho-Fai

doi:10.1007/s10840-019-00542-x

Cited by 4 publications

(7 citation statements)

References 29 publications

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“…The rate of AF recurrence after BP in this study is consistent with previous reports [3,4,7]. Chan et al reported a rate of recurrence of 23% for paroxysmal AF and 41% for non-paroxysmal AF [7]. These findings are in line with the present study, which showed a 25% rate of AF recurrence for paroxysmal AF and 50% for persistent AF.…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

“…Thus, AF recurrence prediction might allow an individualized therapeutic strategy and a reduction of morbidity and mortality in these patients. Large studies which evaluated LA diameter (LAD) and LA volume (LAV) as predictors of AF recurrence after ablation showed controversial results [5,[7][8][9][10][11]. This might be explained by the fact that these methods rely on geometrical assumptions and may not reflect accurately the true atrial remodeling, which is a three-dimensional process [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

Motoc

Scheirlynck

Roosens

et al. 2021

Int J Cardiovasc Imaging

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Cryoballoon ablation (CBA) is a safe and efficient therapeutic option for atrial fibrillation (AF). However, AF recurrence occurs in 25% of the patients, leading to repeated ablations and complications. Previous reports have shown that left atrium (LA) assessed by M-Mode and two-dimensional echocardiography (2DE) predicts AF recurrence. Nevertheless, these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process. We hypothesized that LA remodeling by three-dimensional echocardiography (3DE) has an additional value for AF recurrence prediction post-CBA. 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively recruited. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. 50 (29%) patients had AF recurrence. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50,, p < 0.001). In patients with non-dilated LA diameter index and LAVI by 2DE, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m 2 . LA remodeling by 3DE predicted AF recurrence, even in patients with non-dilated LA by M-Mode and 2DE, suggesting that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and it should be considered for systematic use to evaluate AF recurrence risk post-CBA.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

Motoc

Scheirlynck

Roosens

et al. 2021

Int J Cardiovasc Imaging

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“…Since CB was introduced into mainland China in 2013, the number of CB ablation in the treatment of AF has increased continually. A few studies have reported the long-term outcomes after PVI with CB for Chinese population with AF ( 5 – 7 ). In this study, our aim was to report the 5-year outcomes and predictors of recurrence in a Chinese population who have undergone the treatment of paroxysmal or persistent AF by CB ablation.…”

Section: Introductionmentioning

confidence: 99%

Cryoballoon Ablation for Treatment of Atrial Fibrillation in a Chinese Population: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure

Chen

Xia

Lin

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe 5-year outcomes and predictors of atrial fibrillation (AF) recurrence following cryoballoon (CB) ablation in Chinese population remain scarce. Our aim was to report 5-year outcomes and predictors of AF recurrence following a single CB ablation procedure in a Chinese population.MethodsFrom December 2013 to August 2016, we included 256 consecutive patients (mean age: 58 ± 10.9 years old; female: 41.0%) with paroxysmal or persistent AF successfully underwent first-generation CB ablation at Fuwai hospital in this prospective study. All patients were followed at least 5 years or when there was recurrent AF. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.ResultsThe 5-year success rate after pulmonary vein isolation (PVI) by a single procedure was 59.4%. The recurrence rate was the highest (14.5%) within the first year after the index procedure, and then stabilized. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than patients with persistent AF (63.2% vs. 36.4%, log-rank P < 0.01). The overall incidence of complications related to CB ablation was 7.8%. Phrenic nerve injury (PNI) was the most common complication, with an incidence of 3.5%, and patients with PNI were recovered within the 1-year follow-up. Only persistent AF (HR 1.72, 95%CI 1.028–2.854, P < 0.05) was significantly and independently associated with an increased risk of AF recurrence after adjusting for other factors.ConclusionPulmonary vein isolation using CB ablation was safe and effective with an acceptable complication and 5-year success rate in a Chinese population with AF, and persistent AF was the independent predictor for 5-year AF recurrence after a single CB ablation procedure.

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“…Recent data have shown that left atrium (LA) structural remodeling, defined as LA dilation, predicts AF recurrence after CBA [2,4,5]. However, a growing body of evidence suggests that LA functional assessment might be a more sensitive prognostic indicator of AF recurrence [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation

et al. 2021

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Objective Atrial fibrillation (AF) recurrence occurs in approximately 25% of the patients undergoing cryoballoon ablation (CBA), leading to repeated ablations and complications. Left atrial (LA) dilation has been proposed as a predictor of AF recurrence. However, LA strain is a surrogate marker of LA mechanical dysfunction, which might appear before the enlargement of the LA. The purpose of this study was to evaluate the additional predictive value of LA function assessed using strain echocardiography for AF recurrence after CBA. Methods 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively analyzed. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. Results 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤ 17% had the highest incremental predictive value for AF recurrence (HR = 9.45, 95%CI: 3.17–28.13, p < 0.001). In patients with non-dilated LA, PALS≤17% remained an independent predictor of AF recurrence (HR = 5.39, 95%CI: 1.66–17.52, p = 0.005). Conclusions This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non—dilated LA, PALS also predicted AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of AF patients before CBA.

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Long-term outcomes of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation in Chinese patients

Cited by 4 publications

References 29 publications

Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

Cryoballoon Ablation for Treatment of Atrial Fibrillation in a Chinese Population: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure

Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation

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