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Results and Predictive Factors After One Cryoablation for Persistent Atrial Fibrillation

Published:September 02, 2021DOI:https://doi.org/10.1016/j.amjcard.2021.07.052
      Cryoballoon pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) ablation is an increasingly used strategy. We aimed to determine the results and predictors of arrhythmia recurrence after a single procedure of cryoballoon PVI for patients with persistent and long-standing persistent AF. We included all consecutive patients who underwent cryoballoon PVI for the treatment of persistent symptomatic drug-refractory AF since 2012. All patients were prospectively followed to detect the recurrence of atrial tachyarrhythmia (ATa). Predictors of recurrence were assessed. Cryoballoon PVI was performed on 399 patients with persistent AF, among whom 52 (13%) had long-standing persistent AF. Patients with long-standing persistent AF had a significantly larger left atrium than those with persistent AF. A 28-mm cryoballoon was used for 322 patients (93%). In total, 359 patients (90%) completed the 12-month follow-up visit and the median follow-up was 24 months (interquartile range 43 to 13). The 2-year probability of freedom from ATa recurrence was 51% for persistent AF and 27% for long-standing persistent AF. Long-standing persistent AF and left atrial area/volume were independent predictors of ATa recurrence. Ten patients (2.5%) experienced phrenic nerve palsy, 1 tamponade (0.25%), 2 stroke (0.5%), 2 pericardial effusions (0.5%), and 5 vascular complications (1.25%). In conclusion, 2-year ATa-free survival rates were 51 and 27% for persistent and long-standing persistent AF patients, respectively. Complications were rare. Long-standing persistent AF and left-atrial area/volume were predictors of recurrence.

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      References

        • Verma A
        • Jiang CY
        • Betts TR
        • Chen J
        • Deisenhofer I
        • Mantovan R
        • Macle L
        • Morillo CA
        • Haverkamp W
        • Weerasooriya R
        • Albenque JP
        • Nardi S
        • Menardi E
        • Novak P
        • Sanders P
        • Investigators SAI
        Approaches to catheter ablation for persistent atrial fibrillation.
        N Engl J Med. 2015; 372: 1812-1822
        • Koektuerk B
        • Yorgun H
        • Hengeoez O
        • Turan CH
        • Dahmen A
        • Yang A
        • Bansmann PM
        • Gorr E
        • Hoppe C
        • Turan RG
        • Horlitz M.
        Cryoballoon ablation for pulmonary vein isolation in patients with persistent atrial fibrillation: one-year outcome using second generation cryoballoon.
        Circ Arrhythm Electrophysiol. 2015; 8: 1073-1079
        • Ciconte G
        • Ottaviano L
        • de Asmundis C
        • Baltogiannis G
        • Conte G
        • Sieira J
        • Di Giovanni G
        • Saitoh Y
        • Irfan G
        • Mugnai G
        • Storti C
        • Montenero AS
        • Chierchia GB
        • Brugada P.
        Pulmonary vein isolation as index procedure for persistent atrial fibrillation: one-year clinical outcome after ablation using the second-generation cryoballoon.
        Heart Rhythm. 2015; 12: 60-66
        • Aryana A
        • Singh SM
        • Kowalski M
        • Pujara DK
        • Cohen AI
        • Singh SK
        • Aleong RG
        • Banker RS
        • Fuenzalida CE
        • Prager NA
        • Bowers MR
        • D'Avila A
        • O'Neill PG
        Acute and long-term outcomes of catheter ablation of atrial fibrillation using the second-generation cryoballoon versus open-irrigated radiofrequency: a multicenter experience.
        J Cardiovasc Electrophysiol. 2015; 26: 832-839
        • Guhl EN
        • Siddoway D
        • Adelstein E
        • Voigt A
        • Saba S
        • Jain SK.
        Efficacy of cryoballoon pulmonary vein isolation in patients with persistent atrial fibrillation.
        J Cardiovasc Electrophysiol. 2016; 27: 423-427
        • Tscholl V
        • Lsharaf AK
        • Lin T
        • Bellmann B
        • Biewener S
        • Nagel P
        • Suhail S
        • Lenz K
        • Landmesser U
        • Roser M
        • Rillig A.
        Two years outcome in patients with persistent atrial fibrillation after pulmonary vein isolation using the second-generation 28-mm cryoballoon.
        Heart Rhythm. 2016; 13: 1817-1822
        • Boveda S
        • Providencia R
        • Defaye P
        • Pavin D
        • Cebron JP
        • Anselme F
        • Halimi F
        • Khoueiry Z
        • Combes N
        • Combes S
        • Jacob S
        • Albenque JP
        • Sousa P.
        Outcomes after cryoballoon or radiofrequency ablation for persistent atrial fibrillation: a multicentric propensity-score matched study.
        J Int Cardiac Electrophysiol. 2016; 47: 133-142
        • Lemes C
        • Wissner E
        • Lin T
        • Mathew S
        • Deiss S
        • Rillig A
        • Heeger C
        • Wohlmuth P
        • Reissmann B
        • Tilz R
        • Ouyang F
        • Kuck KH
        • Metzner A
        One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis.
        Europace. 2016; 18: 201-205
        • Straube F
        • Hartl S
        • Dorwarth U
        • Wankerl M
        • Bunz B
        • Ebersberger U
        • Hoffmann E.
        Cryoballoon ablation for persistent atrial fibrillation—large single-center experience.
        J Cardiol. 2016; 68: 492-497
        • Tondo C
        • Iacopino S
        • Pieragnoli P
        • Molon G
        • Verlato R
        • Curnis A
        • Landolina M
        • Allocca G
        • Arena G
        • Fassini G
        • Sciarra L
        • Luzi M
        • Manfrin M
        • Padeletti L
        • ClinicalService SPI
        Pulmonary vein isolation cryoablation for patients with persistent and long-standing persistent atrial fibrillation: Clinical outcomes from the real-world multicenter observational project.
        Heart Rhythm. 2018; 15: 363-368
        • Akkaya E
        • Berkowitsch A
        • Zaltsberg S
        • Greiss H
        • Hamm CW
        • Sperzel J
        • Neumann T
        • Kuniss M.
        Second-generation cryoballoon ablation for treatment of persistent atrial fibrillation: three-year outcome and predictors of recurrence after a single procedure.
        J Cardiovasc Electrophysiol. 2018; 29: 38-45
        • Yalin K
        • Abdin A
        • Lyan E
        • Sawan N
        • Liosis S
        • Elsner C
        • Jobs A
        • Bruggemann B
        • Koester J
        • Eitel I
        • Eitel C
        • Tilz RR.
        Safety and efficacy of persistent atrial fibrillation ablation using the second-generation cryoballoon.
        Clin Res Cardiol. 2018; 107: 570-577
        • Boveda S
        • Metzner A
        • Nguyen DQ
        • Chun KRJ
        • Goehl K
        • Noelker G
        • Deharo JC
        • Andrikopoulos G
        • Dahme T
        • Lellouche N
        • Defaye P.
        Single-procedure outcomes and quality-of-life improvement 12 months post-cryoballoon ablation in persistent atrial fibrillation: results from the multicenter CRYO4PERSISTENT AF trial.
        JACC Clin Electrophysiol. 2018; 4: 1440-1447
        • Sawhney V
        • Schilling RJ
        • Providencia R
        • Cadd M
        • Perera D
        • Chatha S
        • Mercer B
        • Finlay M
        • Halimi F
        • Pavin D
        • Anselme F
        • Cebron JP
        • Chun J
        • Schmidt B
        • Defaye P
        • Dhillon G
        • Boveda S
        • Albenque JP
        • Tayebjee M
        • de Asmundis C
        • Chierchia G
        • Hunter RJ.
        Cryoablation for persistent and longstanding persistent atrial fibrillation: results from a multicentre European registry.
        EP Europace. March 2020; 22: 375-381https://doi.org/10.1093/europace/euz313
        • Reissmann B
        • Plenge T
        • Heeger CH
        • Schluter M
        • Wohlmuth P
        • Fink T
        • Rottner L
        • Tilz RR
        • Mathew S
        • Lemes C
        • Maurer T
        • Luker J
        • Sultan A
        • Bellmann B
        • Goldmann B
        • Ouyang F
        • Kuck KH
        • Metzner A
        • Steven D
        • Rillig A.
        Predictors of freedom from atrial arrhythmia recurrence after cryoballoon ablation for persistent atrial fibrillation: a multicenter study.
        J Cardiovasc Electrophysiol. 2019; 30: 1436-1442
        • Su WW
        • Reddy VY
        • Bhasin K
        • Champagne J
        • Sangrigoli RM
        • Braegelmann KM
        • Kueffer FJ
        • Novak P
        • Gupta SK
        • Yamane T
        • Calkins H
        • Investigators SPA
        Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: results from the multicenter STOP persistent AF trial.
        Heart Rhythm. 2020; 17: 1841-1847https://doi.org/10.1016/j.hrthm.2020.06.020
        • Hindricks G
        • Potpara T
        • Dagres N
        • Arbelo E
        • Bax JJ
        • Blomstrom-Lundqvist C
        • Boriani G
        • Castella M
        • Dan GA
        • Dilaveris PE
        • Fauchier L
        • Filippatos G
        • Kalman JM
        • La Meir M
        • Lane DA
        • Lebeau JP
        • Lettino M
        • Lip GYH
        • Pinto FJ
        • Thomas GN
        • Valgimigli M
        • Van Gelder IC
        • Van Putte BP
        • Watkins CL
        • Group ESCSD
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2021; 42: 373-498
        • Williams B
        • Mancia G
        • Spiering W
        • Agabiti Rosei E
        • Azizi M
        • Burnier M
        • Clement DL
        • Coca A
        • de Simone G
        • Dominiczak A
        • Kahan T
        • Mahfoud F
        • Redon J
        • Ruilope L
        • Zanchetti A
        • Kerins M
        • Kjeldsen SE
        • Kreutz R
        • Laurent S
        • Lip GYH
        • McManus R
        • Narkiewicz K
        • Ruschitzka F
        • Schmieder RE
        • Shlyakhto E
        • Tsioufis C
        • Aboyans V
        • Desormais I
        • Authors/Task Force M
        2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension.
        J Hyperten. 2018; 36: 1953-2041
        • Traulle S
        • Miyazaki S
        • Mouquet V
        • Kubala M
        • Hermida JS.
        The anatomic impact of sequential, additional, ostial radiofrequency ablation following pulmonary vein cryo-isolation.
        PACE. 2012; 35: 1420-1427
        • Clarnette JA
        • Brooks AG
        • Mahajan R
        • Elliott AD
        • Twomey DJ
        • Pathak RK
        • Kumar S
        • Munawar DA
        • Young GD
        • Kalman JM
        • Lau DH
        • Sanders P.
        Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis.
        Europace. 2018; 20: f366-f376
        • Kirchhof P
        • Camm AJ
        • Goette A
        • Brandes A
        • Eckardt L
        • Elvan A
        • Fetsch T
        • van Gelder IC
        • Haase D
        • Haegeli LM
        • Hamann F
        • Heidbuchel H
        • Hindricks G
        • Kautzner J
        • Kuck KH
        • Mont L
        • Ng GA
        • Rekosz J
        • Schoen N
        • Schotten U
        • Suling A
        • Taggeselle J
        • Themistoclakis S
        • Vettorazzi E
        • Vardas P
        • Wegscheider K
        • Willems S
        • Crijns H
        • Breithardt G
        • Investigators E-AT
        Early rhythm-control therapy in patients with atrial fibrillation.
        N Engl J Med. 2020; 383: 1305-1316
        • Andrade JG
        • Khairy P
        • Guerra PG
        • Deyell MW
        • Rivard L
        • Macle L
        • Thibault B
        • Talajic M
        • Roy D
        • Dubuc M.
        Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies.
        Heart Rhythm. 2011; 8: 1444-1451
        • Kuck KH
        • Brugada J
        • Furnkranz A
        • Metzner A
        • Ouyang F
        • Chun KR
        • Elvan A
        • Arentz T
        • Bestehorn K
        • Pocock SJ
        • Albenque JP
        • Tondo C
        • Fire, Investigators ICE
        Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation.
        N Engl J Med. 2016; 374: 2235-2245
        • Ratajczak P
        • Slawinska A
        • Martynowska-Rymer I
        • Strzesniewski P
        • Rusak G.
        Anatomical evaluation of the pulmonary veins and the left atrium using computed tomography before catheter ablation: reproducibility of measurements.
        Polish J Radiol. 2016; 81: 228-232
        • Mahabadi AA
        • Samy B
        • Seneviratne SK
        • Toepker MH
        • Bamberg F
        • Hoffmann U
        • Truong QA.
        Quantitative assessment of left atrial volume by electrocardiographic-gated contrast-enhanced multidetector computed tomography.
        J Cardiovasc Comput Tomogr. 2009; 3: 80-87
        • Mujovic N
        • Marinkovic M
        • Markovic N
        • Shantsila A
        • Lip GY
        • Potpara TS.
        Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: the MB-LATER clinical score.
        Sci Rep. 2017; 7: 40828
        • Winkle RA
        • Jarman JW
        • Mead RH
        • Engel G
        • Kong MH
        • Fleming W
        • Patrawala RA.
        Predicting atrial fibrillation ablation outcome: the CAAP-AF score.
        Heart Rhythm. 2016; 13: 2119-2125