Long‐term outcomes of index cryoballoon ablation or point‐by‐point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure

Prabhu, Sandeep; Ahluwalia, Nikhil; Tyebally, Sara; Dennis, Adam; Malomo, Samuel; Abiodun, Aderonke; Tyrlis, Angelos; Dhillon, Gurpreet; Segan, Louise; Graham, Aaron; Honarbakhsh, Shohreh; Sawhney, Vinit; Sporton, Simon; Finlay, Malcolm; Earley, Mark J.; Lambiase, Pier D.; Schilling, Richard J.; Hunter, Ross J.

doi:10.1111/jce.14923

Cited by 7 publications

(18 citation statements)

References 23 publications

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“…The quality assessment utilized the ROBINS‐1 tool to assess selection bias, confounding bias, intervention classification bias, incomplete outcome data, outcome measurement, and reporting bias. Four studies showed moderate overall bias, 16–18,20 while one was serious, 19 and the last one was critical 15 . Figure 2 shows the detailed quality assessment done on all the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Pruszkowska et al 20 observed a significant reduction in the AF burden postprocedure in patients with HFrEF (18.5% vs. 52.9%; p = .001). Following a single CBA treatment, Prabhu et al 18 reported that 70% of patients maintained freedom from atrial arrhythmia recurrence over 12 months. A comparable early recurrence rate of atrial arrhythmia was identified among patient groups with no HF, HFpEF, HFmrEF, and HFrEF (16.2% vs. 15.4% vs. 14.9% vs. 12.2%, p = .798) 15 .…”

Section: Discussionmentioning

confidence: 99%

“…After excluding one study at a time, sensitivity analysis utilized the leave-one-out method, which showed no statistical difference with the overall outcome except for freedom from AF after 2 years. We conducted a systematic review of a total of six studies [15][16][17][18][19][20] with 365 HFrEF patients. Our findings significantly improved LVEF and NYHA classification in HFrEF patients (p = .00).…”

Section: Publication Bias and Sensitivity Analysismentioning

confidence: 99%

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Cryoballoon ablation for atrial fibrillation in patients with heart failure and reduced left ventricular ejection fraction: A systematic review and meta‐analysis

Taha,

Hendi,

Elwekel

et al. 2023

Clinical Cardiology

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The coexistence of atrial fibrillation (AF) with heart failure (HF) is prevalent, leading to severe complications. This review aimed to investigate the success rate and efficacy of cryoballoon ablation (CBA) by measuring the improvement in the New York Heart Association (NYHA) classification and the effect on the left ventricular systolic function in patients with AF accompanied by heart failure with reduced ejection fraction (HFrEF). Electronic databases search included PubMed, Web of Science, and Scopus in January 2023. Outcomes addressed the following: left ventricular ejection fraction (LVEF) improvement, AF recurrence, NYHA classification improvement, and mortality. STATA 17.0 software was used for data analysis. The effect size for the studies was a standard mean difference (SMD) with a 95% confidence interval (CI) for outcomes. Proportion analysis with 95% CI was used for freedom from early AF and AF after 2 years and all‐cause death. We included six studies, including 1699 HF patients with 365 HFrEF patients. The SMD of postoperative LVEF compared to preoperative LVEF in HFrEF was 0.99 ([95% CI: 0.60, 1.39], p = .00), and for NYHA was −1.12 ([95% CI: −1.36, −0.87], p = .00). The analysis results in HFrEF patients for freedom from AF after 1 year was 65% ([95% CI: 0.55, 0.75], and after 2 years was 39% ([95% CI: 0.10, 0.67]). Proportional analysis was conducted for all‐cause death, resulting in 3% mortality ([95% CI: −0.01, 0.07]). Cryoablation of AF accompanied by HFrEF appeared safe as it reduced AF recurrence and enhanced clinical outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Publication Bias and Sensitivity Analysismentioning

confidence: 99%

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Cryoballoon ablation for atrial fibrillation in patients with heart failure and reduced left ventricular ejection fraction: A systematic review and meta‐analysis

Taha,

Hendi,

Elwekel

et al. 2023

Clinical Cardiology

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“…Indeed, a recent review [ 40 ] reported that, in the population of heart failure patients at functional stages I–III, catheter ablation decreases all-cause mortality and improves all-atrial arrhythmia recurrence rate as well as cardiac function when compared to medical management—findings are still inconclusive regarding the sickest heart failure patients, at functional stage IV. Focusing on CB ablation, long-term outcomes on functional stage and ejection fraction appear favorable and equivalent to those achieved with the RF-based approach [ 41 , 42 ].…”

Section: Patient Selection For Af Ablation Through Cryoablationmentioning

confidence: 99%

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Tsiachris

Antoniou

Doundoulakis

et al. 2023

JCDD

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Nowadays, the cryoballoon (CB) constitutes an established alternative to radio frequency (RF) ablation for pulmonary vein isolation (PVI), which offers the possibility to isolate the PVs with a single application. Since the introduction of the second-generation CB, we prospectively collected our data to optimize the procedure on >1000 consecutive patients who underwent CB PVI performed in our center. It is expected that subsequent guidelines will suggest first-line PVI through CB in patients with paroxysmal AF with a class I indication. Indeed, in the long-term follow-up (36 months) of the EARLY-AF trial, CB had a lower incidence of persistent atrial fibrillation episodes compared to the anti-arrhythmic drugs group. We now review the current best practices in an effort to drive consistent outcomes and minimize complications. PV isolation through CB is the most studied single-shot technique for atrial fibrillation ablation, having shown the potential to alter the natural history of the arrhythmia. Several procedural tips and tricks can improve procedural flow and effectiveness. In the present article we provided not only technical details but measurable biophysical parameters that can reliably guide the operator into achieving the best outcome for his patients.

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“…International Journal of General Medicine 2021:14 11 reported that an increase in the preoperative LAD and a long duration of AF were high-risk factors for AF recurrence following radiofrequency ablation. Prabhu et al 12 believed that the inner diameter of the left atrium might directly affect the ablation result, and patients with AF and a left atrium inner diameter >55 mm were likely to experience AF recurrence in the long term. Domestically, Kirchhof et al 13 reported that the sinus rhythm cardioversion rate following radiofrequency ablation was significantly higher in patients with AF of less than two years duration as compared with patients in AF for more than two years.…”

Section: Dovepressmentioning

confidence: 99%

Effects of Modified Simultaneous Unipolar Saline-Irrigated Radiofrequency Ablation in Patients with Atrial Fibrillation Combined with Mitral Valve Disease

Jiang¹,

Gu²,

Song³

et al. 2021

IJGM

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To investigate the therapeutic effects of a modified simultaneous unipolar salineirrigated radiofrequency ablation by intracardiac operation under direct vision in patients with mitral valve diseases combined with atrial fibrillation (AF). Methods: A total of 168 patients with mitral valve diseases combined with AF who underwent unipolar saline-irrigated radiofrequency ablation modified maze procedures were enrolled and divided into the mitral stenosis (MS) group (n = 87) and the mitral insufficiency (MI) group (n = 81). Results: Those with a left atrium diameter (LAD) < 55 mm had a better cardioversion effect during the mid-term post-operation than those with a LAD ≥ 55 mm (P < 0.05). The cardioversion effect during the mid-term post-operation was better in those with a duration of AF < 2 years than those with AF ≥ 2 years (P < 0.05). The LAD reduced significantly during the early postoperative period in the MS group (P < 0.05). Compared with the early postoperative period, LAD further reduced, and the EF increased significantly during the mid-term post-operation (P<0.05). The LAD reduced significantly during the early postoperative period in the MI group (P < 0.05), together with relatively decreased EF (P < 0.05). Compared with the early postoperative period, LAD further reduced, and the EF increased significantly during the mid-term post-operation (P<0.05). The improvement of LAD in the MI group during the mid-term postoperation was better than that in the MS group (P < 0.05). Conclusion:The cardioversion effects and the improvement in cardiac function during the mid-term post-operation were good in the radiofrequency ablation by intracardiac operation under direct vision in patients with different mitral valve diseases combined with AF. The cardioversion effects during the early postoperative period and the mid-term post-operation were better in patients with MI than in those with MS.

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Long‐term outcomes of index cryoballoon ablation or point‐by‐point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure

Cited by 7 publications

References 23 publications

Cryoballoon ablation for atrial fibrillation in patients with heart failure and reduced left ventricular ejection fraction: A systematic review and meta‐analysis

Cryoballoon ablation for atrial fibrillation in patients with heart failure and reduced left ventricular ejection fraction: A systematic review and meta‐analysis

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Effects of Modified Simultaneous Unipolar Saline-Irrigated Radiofrequency Ablation in Patients with Atrial Fibrillation Combined with Mitral Valve Disease

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