ABSTRACT
Introduction Cryoballoon ablation (CB) has proven effective to treatment of patients (pts) with atrial fibrillation (AF). However, the isolated efficacy of CB to treat pts with long-standing persistent atrial fibrillation (LSPAF) is less know. We analyzed the acute results and the long-term follow-up of our pts suffering LSPAF and initially treated with CB. Methods A cohort of 44 pts, 37 male (84%) mean age (60±10 year) suffering LSPAF were treated with first (CB1): 15pts, and second (CB2): 29 pts, generation CB. Eight pts (18.1%) had structural heart disease. Prior to CB, all pts were previously electrically cardioverted (CV) and sinus node and A-V nodal function evaluated at electrophysiological study (EP) once in sinus rhythm (SR) before antiarrhythmic drugs (AAD) load. CB ablation procedure was performed after three months waiting period on AAD following CV/EP drug testing. Result CB procedure was performed in 27 (61.4%) in AF, restoring SR in 8 (18.2%). PV isolation (PVI) was achieved in 95.2%. On follow-up of 30±39 months, 16 pts (40%) had AF recurrence. Second procedure (Redo) was performed in 7 pts. After a single procedure, 24 pts (60%) remain in SR without AAD, after Redo, 29 pts (72.5%), and when AAD added, 31 pts (77.5%) remain in SR. Phrenic nerve palsy (PNP) occurred in 9% of pts (75% with CB2). Conclusion CB technique is safe and useful tool to treat pts with LSPAF with 60% success rate maintaining SR without AAD in a long-term follow-up (30±39 months), up to 72.5% after Redo, and to 77.5% when AAD are added. In the majority of pts maintaining SR (77.5%) CB2 was used in 87% of the cases. Patients without structural heart disease along with those who SR was restored during CB showed the best result.
ABSTRACT
INTRODUCTION: Cryoballoon ablation (CB) has proven effective for treating patients with paroxysmal atrial fibrillation (PAF). We analyzed our seven year follow-up of patients, treated for PAF with first (CB1) and second generation (CB2), with demonstration of LA-PV disconnection with bidirectional block (BB) after adenosine (AD). METHODS: Since November 2008 to May 2015, 128 patients, 97 male (58±7 years), without heart disease, highly symptomatic, refractory to antiarrhythmic drugs (AAD) were treated, and follow-up (1411 ±727 days). Left atrial size: 37±6 mm. RESULTS: A total of 439 PV were successfully isolated (91.9%). Acute reconduction: 44 PV (9%): 16 after CB; 16 unmasked by AD; 12 extrapulmonary muscular connections (EMC). Main complication was phrenic nerve palsy (PNP): 9 (7 %). On follow-up, 114 patients (89%) remain asymptomatic in sinus rhythm (SR), free of medication. Fourteen patients (11%) had arrhythmia recurrence: 12 male (52±8 years). Early recurrences occurred in 9 male. Late recurrences presented 3 male at 24, 27 and 60 months, and 2 female at 7 and 40 months respectively. All recurrence patients were Redo, and remain in SR without medication during follow-up. CONCLUSIONS: CB alone is very effective and safe for the definitive treatment of patients suffering PAF with 72.6% success rate, increasing up to 89.1% when this protocol is applied in a single procedure. After Redo, all population group (100%), remain in sinus rhythm, freedom of arrhythmia, without AAD, in this very long term follow-up. Checking for BB, AD protocol, and ruling out EMC allowed-us to identified 14.8% of patients with underlying substrate for potential arrhythmia recurrence. CB2 applications entail a highest risk of PNP. Patients with a rough estimated profile of low ALARMEc score (≤ 1) have an excellent long term outcome, being this series the largest follow-up described so far, for patients treated for PAF with CB.
ABSTRACT
Electrical isolation of the pulmonary veins and disconnection of the left atrial musculature from their arrhythmogenic effects is the cornerstone of definitive and curative treatment in patients with symptomatic recurrent paroxysmal atrial fibrillation that is refractory to antiarrhythmic therapy. The type of lesion produced by balloon cryoablation is such that the tissue architecture is preserved and thrombus formation and the risk of pulmonary vein stenosis are reduced. We report on immediate outcomes in the first five patients who underwent treatment. These cases represent initial experience with the technique in Spain. A total of 20 pulmonary veins were treated and complete acute electrical isolation was achieved in all cases (100%). Patients were discharged from hospital within 72 hours of the procedure, and there were no complications. In conclusion, balloon cryoablation of the pulmonary veins is a practical, safe and effective technique for achieving the electrophysiologic goal of acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
Subject(s)
Atrial Fibrillation/surgery , Catheterization , Cryosurgery , Pulmonary Veins/surgery , Aged , Female , Humans , Male , Middle AgedABSTRACT
El aislamiento de las venas pulmonares y la desconexión del músculo auricular izquierdo de la actividad arritmogénica de éstas son la piedra angular del tratamiento definitivo y curativo en pacientes con fibrilación auricular paroxística recurrente y sintomática refractaria a tratamiento antiarrítmico. La lesión producida por frío con catéter-balón preserva la arquitectura tisular, disminuye la formación de trombos y el riesgo de estenosis venosa pulmonar. Presentamos los resultados inmediatos conseguidos en los primeros 5 pacientes, que constituyen la experiencia inicial en España. Se trataron un total de 20 venas pulmonares, y se demostró aislamiento eléctrico agudo completo en todas (100%). Los pacientes fueron dados de alta dentro de las primeras 72 h del procedimiento, sin complicaciones. En conclusión, la crioablación con catéter-balón de las venas pulmonares es una técnica factible, segura y eficaz para conseguir el objetivo final electrofisiológico de aislamiento agudo de ellas en pacientes con fibrilación auricular paroxística (AU)
Electrical isolation of the pulmonary veins and disconnection of the left atrial musculature from their arrhythmogenic effects is the cornerstone of definitive and curative treatment in patients with symptomatic recurrent paroxysmal atrial fibrillation that is refractory to antiarrhythmic therapy. The type of lesion produced by balloon cryoablation is such that the tissue architecture is preserved and thrombus formation and the risk of pulmonary vein stenosis are reduced. We report on immediate outcomes in the first five patients who underwent treatment. These cases represent initial experience with the technique in Spain. A total of 20 pulmonary veins were treated and complete acute electrical isolation was achieved in all cases (100%). Patients were discharged from hospital within 72 hours of the procedure, and there were no complications. In conclusion, balloon cryoablation of the pulmonary veins is a practical, safe and effective technique for achieving the electrophysiologic goal of acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation (AU)
