Two years outcome in patients with persistent atrial fibrillation after pulmonary vein isolation using the second-generation 28-mm cryoballoon

Tscholl, Verena; Lsharaf, Abdullah Khaled-A.; Lin, Tina; Bellmann, Barbara; Biewener, Sebastian; Nagel, Patrick; Suhail, Saba; Lenz, Klaus; Landmesser, Ulf; Roser, Mattias; Rillig, Andreas

doi:10.1016/j.hrthm.2016.05.022

Cited by 41 publications

(43 citation statements)

References 24 publications

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“…Consequently, with a shorter follow‐up, the success rate in our study for paroxysmal atrial fibrillation was comparable to that reported in the literature. Our success rate for persistent atrial fibrillation, calculated after repeated procedures, was slightly higher than that reported by Tscholl et al., obtained after a single procedure. Apart from differences in study populations, the monitoring methods used to detect intermittent recurrences may also explain the differences observed between the two studies.…”

Section: Discussioncontrasting

confidence: 64%

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Prevalence and predictive factors of left atrial tachycardia occurring after second‐generation cryoballoon ablation of atrial fibrillation

Hermida

Kubala

Traullé

et al. 2017

Cardiovasc electrophysiol

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Introduction: Assess the prevalence and predictors of left atrial tachycardia (LAT) after cryoballoon ablation of pulmonary veins. Methods and results:Patients who underwent catheter ablation of pulmonary veins with a second-generation cryoballoon for symptomatic paroxysmal (151 of 270, 56%) or persistent (119 of 270, 44%) atrial fibrillation were entered in a single-center prospective registry. Patients who experienced postcryoballoon LAT (pcryo-LAT) were selected on the basis of 12-lead ECG characteristics. Left atrial origin was confirmed during conventional EP study and electroanatomical activation mapping, and patients were treated by RF catheter ablation.Pcryo-LAT was observed in 15 (5.6%) of 270 patients and was attributed to a reentrant mechanism in 11 patients (73%). The other four cases of pcryo-LAT were due to focal atrial tachycardia associated with reconnection of one pulmonary vein. In comparison with patients who remained in sinus rhythm, LA area (HR = 1.09; CI 1.01, 1.2; P = 0.02), LVEF (HR = 0.94; CI 0.90, 0.97; P < 0.001), and LVEF <50% (HR = 8.5; CI 3.1, 23.6; P < 0.001) were predictors of pcryo-LAT. After multivariate Cox analysis, only left ventricular ejection fraction < 50% remained predictive of pcryo-LAT, (HR = 7.8, CI 2.3 26.7, P = 0.002). With a mean survival of 23 months, 73% of patients who experienced pcryo-LAT were in sinus rhythm versus 78% of patients without pcryo-LAT (log rank P = 0.85). Conclusion:The prevalence of pcryo-LAT in patients with atrial fibrillation is low. Left ventricular ejection fraction < 50% is associated with an increased risk of pcryo-LAT. When treated by RF catheter ablation, the presence of pcryo-LAT is not a predictive factor of subsequent recurrence of atrial fibrillation during follow-up.

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Section: Discussioncontrasting

confidence: 64%

“…Success rates published in studies with similar follow‐up were 80% for paroxysmal atrial fibrillation with a mean follow‐up of 38 months and repeated procedures . The success rate for persistent atrial fibrillation was 56% with a follow‐up of 22 months and only one procedure …”

Section: Discussionmentioning

confidence: 88%

Prevalence and predictive factors of left atrial tachycardia occurring after second‐generation cryoballoon ablation of atrial fibrillation

Hermida

Kubala

Traullé

et al. 2017

Cardiovasc electrophysiol

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“…The efficacy of CB‐Adv in patients with paroxysmal AF has been demonstrated in several clinical trials with promising success rates. Five observational studies provided data on the short‐ to midterm outcome in patients after PVI using CB‐Adv for the treatment of persistent AF, being in line with published data after RF ablation . Interest in using CB‐Adv for PVI is increasing, because procedure times are shorter with CB ablation than with RF ablation, due to reduced freeze cycle times and single‐shot applications, not being associated with smaller lesion surface areas using nitrous oxide as refrigerant …”

Section: Discussionsupporting

confidence: 54%

“…These catheters have been shown to improve procedural success, and may account for some of the clinical outcome seen in this study. However, this evidence has allowed among others for the expansion of the initial indication for PVI using CB, resulting in its adoption as the first approach even among patients with persistent AF …”

Section: Discussionmentioning

confidence: 99%

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Second‐generation cryoballoon ablation for treatment of persistent atrial fibrillation: Three‐year outcome and predictors of recurrence after a single procedure

Akkaya

Berkowitsch

Zaltsberg

et al. 2017

Cardiovasc electrophysiol

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Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second‐generation cryoballoon

Tscholl

Lsharaf

Lin

et al. 2017

Clinical Cardiology

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Background Data are limited on the safety of periprocedural anticoagulation with novel oral anticoagulants (NOACs) in patients undergoing pulmonary vein isolation (PVI) using the second‐generation cryoballoon (CB) for the treatment of atrial fibrillation. Hypothesis We hypothesized that the incidence of acute periprocedural complications in patients undergoing PVI do not differ between patients treated with VKA compared to NOACs. Methods In 200 consecutive patients (mean age, 64.3 _ 10.6 years; female, n = 83) with symptomatic atrial fibrillation, PVI using the second‐generation 28‐mm CB was performed. In patients treated with NOACs, the medication was stopped the day of the procedure and continued the evening after the procedure with a reduced dosage. Patients treated with phenprocoumon were continued on uninterrupted phenprocoumon with a target INR of 2 to 3. If INR was <2, bridging with low‐molecular‐weight heparin was performed. Results Forty‐seven of 200 patients (23.5%) were treated with a vitamin K antagonist (VKA) and 55 (27.5%) were treated with apixaban, 67 (33.5%) with rivaroxaban, and 31 (15.5%) with dabigatran. Seven (3.5%) major complications occurred in the overall population. Major bleeding complications did not differ significantly between the 2 groups (P = 0.23). One patient taking VKA had a pericardial tamponade at the end of the procedure; 2 patients treated with apixaban developed a groin hematoma requiring surgical intervention. Transient ischemic attack occurred in 1 patient of the apixaban and rivaroxaban group. Conclusions Apixaban, rivaroxaban, and dabigatran, compared with uninterrupted VKA, did not show a higher risk for major bleeding or ischemic complications in patients undergoing PVI using the second‐generation CB.

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Two years outcome in patients with persistent atrial fibrillation after pulmonary vein isolation using the second-generation 28-mm cryoballoon

Cited by 41 publications

References 24 publications

Prevalence and predictive factors of left atrial tachycardia occurring after second‐generation cryoballoon ablation of atrial fibrillation

Prevalence and predictive factors of left atrial tachycardia occurring after second‐generation cryoballoon ablation of atrial fibrillation

Second‐generation cryoballoon ablation for treatment of persistent atrial fibrillation: Three‐year outcome and predictors of recurrence after a single procedure

Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second‐generation cryoballoon

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