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Safety and efficacy of persistent atrial fibrillation ablation using the second-generation cryoballoon

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Abstract

Background

The second-generation cryoballoon (CB) is increasingly used for treatment of persistent atrial fibrillation (AF). Data regarding the clinical outcome and mechanism of arrhythmia recurrence following persistent AF ablation using CB is sparse. In this study, we aimed to assess the efficacy of CB and mechanisms of atrial tachyarrhythmia (ATA) recurrence in patients with persistent AF.

Methods and results

A total of 133 patients (66 ± 10 years, 60% male) with symptomatic persistent AF, who were scheduled for PVI using the second-generation CB were enrolled. Follow-up included 24 h Holter recording at 3, 6 and 12 months. Any documented episode of ATA lasting more than 30 s was considered as a recurrent arrhythmic event. All targeted veins were isolated (100%). Phrenic nerve palsy with recovery during follow-up occurred in six patients (4.5%), no patient experienced tamponade or a cerebrovascular event. During 12.6 ± 5.4 months of follow-up, 89/133 (67%) patients were free of ATA recurrences. Multivariable analysis revealed recurrence in the blanking period (HR 11.46, 0.95 CI 3.92–33.49, p < 0.001), presence of cardiomyopathy (HR 2.75, 0.95 CI 1.09–6.96, p = 0.032) and PV abnormality (HR 3.56, 0.95 CI 1.21–10.43, p = 0.021) as predictors for late recurrence.

Conclusion

In patients with persistent AF, second-generation cryoballoon use is associated with an excellent safety profile and favorable outcomes. Arrhythmia recurrence during the blanking period, presence of cardiomyopathy and PV abnormality were independent predictors of long-term AF recurrence.

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Abbreviations

ATA:

Atrial tachyarrhythmia

AF:

Atrial fibrillation

CB:

Cryoballoon

CMP:

Cardiomyopathy

CTI:

Cavotricuspid isthmus

EHRA:

European Heart Rhythm Association

ICD:

Implantable cardioverter defibrillator

INR:

International normalized ratio

LA:

Left atrium

LCPV:

Left common pulmonary vein

LIPV:

Left inferior pulmonary vein

LSPV:

Left superior pulmonary vein

LVEF:

Left ventricular ejection fraction

PM:

Pacemaker

PNP:

Phrenic nerve palsy

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

RIPV:

Right inferior pulmonary vein

RMPV:

Right middle pulmonary vein

RSPV:

Right superior pulmonary vein

RF:

Radiofrequency

SR:

Sinus rhythm

References

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Acknowledgements

K. Yalin recieved research and educational grant from Turkish Society of Cardiology. E. Lyan received travel grants and Speaker’s Bureau Honoraria from Biosense Webster, Medtronic, Boston Scientific. R. Tilz received travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi Sankyo, Sentrheart and Speaker’s Bureau Honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sanofi Aventis.

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Authors and Affiliations

  1. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Kivanc Yalin, Amr Abdin, Evgeny Lyan, Noureddin Sawan, Spyridon Liosis, Christian Elsner, Alexander Jobs, Ben Brüggemann, Jelena Koester, Ingo Eitel, Charlotte Eitel & Roland Richard Tilz

  2. Department of Cardiology, Faculty of Medicine, Usak University, Usak, Turkey

    Kivanc Yalin

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  1. Kivanc Yalin
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  2. Amr Abdin
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Correspondence to Roland Richard Tilz.

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Yalin, K., Abdin, A., Lyan, E. et al. Safety and efficacy of persistent atrial fibrillation ablation using the second-generation cryoballoon. Clin Res Cardiol 107, 570–577 (2018). https://doi.org/10.1007/s00392-018-1219-1

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  • DOI: https://doi.org/10.1007/s00392-018-1219-1

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