The efficacy and safety of cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation.

BACKGROUND: Electrical isolation of pulmonary vein ostia is an established therapy for paroxysmal atrial fibrillation. AIMS: The purpose of this study is to evaluate the long-term efficacy and safety of cryoballoon catheter ablation in paroxysmal atrial fibrillation with normal anatomy of the left atrium. METHODS: Two hundred fifteen consecutive patients were included in the study (from November 2014 to November 2016). All the patients had symptoms of paroxysmal atrial fibrillation resistant to antiarrhythmic drugs and underwent pulmonary vein cryoisolation using second-generation cryoballoons. Standard "single-shot" cryoballoon exposures were used alternately for each of the four pulmonary veins. The endpoint of the ablation procedure was the electrical isolation of each pulmonary vein. RESULTS: Sixty-nine patients had stable atrial fibrillation recurrences and left atrial flutter with 30 of 69 patients having atrial fibrillation paroxysms during the first year after primary ablation. Repeated ablation was performed within 6-12 months after the first ablation. In 39 of 69 cases, arrhythmia recurrences were registered during the second and third year after the first ablation. These patients underwent repeated ablation within 12-36 months after the first ablation. In 98% of the patients, no disease progression with a transition to a persistent form of atrial fibrillation was observed. During the mean 5-year follow-up period, no disease progression with the transition to persistent forms of atrial fibrillation was observed. CONCLUSIONS: It was concluded that in patients with paroxysmal atrial fibrillation, with normal left atrium anatomy and no risk factors, it can be controlled with single pulmonary vein isolation without additional atrial substrate modification.

Prediction of arrhythmia recurrence after atrial fibrillation ablation in patients with normal anatomy of the left atrium.

BACKGROUND: Enlarged left atrium is an established predictor of atrial fibrillation recurrence after pulmonary vein isolation but arrhythmia recurrence is also observed in patients with normal anatomy of the left atrium. The aim of the study is to evaluate arrhythmia recurrence predictors in patients with normal anatomy of the left atrium. METHODS: The study included 182 patients with normal anatomy of the left atrium who underwent pulmonary vein isolation using catheter ablation. Various parameters were also compared, including age, gender, history of arrhythmia, arterial hypertension, concomitant coronary pathology, echocardiography findings, such as mitral valve and tricuspid valve regurgitation and procedure parameters, between patients with and without relapses. Statistical analysis was performed using the IBM SPSS Statistics-19 software. RESULTS: Transthoracic echocardiography was performed by independent specialists with extensive experience. Trans-esophageal echocardiography was performed before each ablation procedure. Standard trans-septal puncture was performed under fluoroscopic control. Radiofrequency ablation was performed in the ipsilateral pulmonary vein antrum with a wide capture of nearby lung tissue. CONCLUSIONS: It was concluded that the tricuspid valve regurgitation and arterial hypertension correlate with atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial anatomy.