Single-Procedure Outcomes and Quality-of-Life Improvement 12 Months Post-Cryoballoon Ablation in Persistent Atrial Fibrillation: Results From the Multicenter CRYO4PERSISTENT AF Trial.

OBJECTIVES: The CRYO4PERSISTENT AF (Cryoballoon Ablation for Early Persistent Atrial Fibrillation) trial aims to report long-term outcomes after a single pulmonary vein isolation (PVI)-only ablation procedure using the second-generation cryoballoon in persistent atrial fibrillation (PerAF) patients. BACKGROUND: Pulmonary vein isolation is recognized as the cornerstone of atrial fibrillation (AF) ablation, including ablation of PerAF. METHODS: The CRYO4PERSISTENT AF trial (NCT02213731) is a prospective, multicenter, single-arm trial designed to assess single-procedure outcomes of PVI using the cryoballoon. The primary endpoint was freedom from AF, atrial flutter, or atrial tachycardia ≥30 s after a 90-day blanking period. After enrollment, but before ablation, patients without 100% AF burden (18-h Holter monitoring or 3 consecutive electrocardiograms in a time frame ≥14 days) were excluded. Patients were followed at 3, 6, and 12 months, with 48-h Holter monitoring at 6 and 12 months. Quality of life and symptoms were evaluated at baseline and 12 months. Arrhythmia recurrence and adverse events were adjudicated by an independent committee. RESULTS: A total of 101 patients (62 ± 11 years of age, 74% men, left ventricular ejection fraction 56 ± 8%, left atrial diameter 43 ± 5 mm) meeting criteria, undergoing cryoballoon-based PVI, with follow-up data, were included. Kaplan-Meier estimate of freedom from AF, atrial flutter, or atrial tachycardia recurrence was 60.7% at 12 months. Compared with baseline, there were significantly fewer patients with arrhythmia-related symptoms at 12 months (16% vs. 92%; p < 0.0001). The symptom reduction was supported by significant improvement in 36-Item Short Form Health Survey composite scores and European Heart Rhythm Association score at 12 months. The only device related event was transient phrenic nerve injury in 2 (2%) patients, with resolution pre-discharge. CONCLUSIONS: Cryoballoon ablation for treatment of PerAF demonstrated 61% single-procedure success at 12 months post-ablation in addition to significant reduction in arrhythmia-related symptoms and improved quality of life. (Cryoballoon Ablation for Early Persistent Atrial Fibrillation [Cryo4 Persistent AF]; NCT02213731).

[Fragments of medico-historical interest in the Landeskirchliche Archiv Kassel]. / Die medizinisch-pharmazeutischen Fragmente Allendorf Rechnungseinband 1641 (Nr. 20) sowie Mengeringhausen Rechnungseinband 1639 (Nr. 62) aus dem Landeskirchlichen Archiv Kassel.

A systematic survey in the Landeskirchliche Archiv Kassel of medieval manuscript fragments which have survived in the binding of documents in parish archives has uncovered a treasure of liturgical, theological and legal texts. This paper presents two fragments of medico-historical interest: two folios from a pharmaceutical treatise, which could not be identified more precisely, and a passage from the commentary to Gilles de Corbeil's well-known 'Carmen de urinis'. A modern edition of this commentary, which was probably written by Gilles himself, would be very welcome.

[Appendix to the "Darmstadt Johannes-Alexandrinus Fragment"]. / Nachträge zum "Darmstädter Johannes-Alexandrinus-Fragment".

This appendix to "Das Darmstädter Johannes-Alexandrinus-Fragment" answers to the critical note by Klaus-Dietrich Fischer, and shows that these new-founded fragments are a testimony of an until now unknown abbreviated version of the Alexandrinian commentary on Galen's book 'De sectis'.