Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation

A multicenter experience

Arash Aryana, James H. Baker, Martin A. Espinosa Ginic, Deep K. Pujara, Mark R. Bowers, P. Gearoid O'Neill, Kenneth A. Ellenbogen, Luigi Di Biase, André d'Avila, Andrea Natale

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). Objective: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF). Methods: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9%]) vs PVI alone (n = 168 [43.1%]). Results: Acute isolation was achieved in 99.7% of all pulmonary veins (PVI+PWI = 99.8% vs PVI alone = 99.3%; P =.23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8% of patients to complete PVI (4 ± 2 minutes) and in 32.4% to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2% ± 6.4% vs 40.6% ± 4.9%; P <.001) and total left atrial (53.3% ± 4.2% vs 36.3% ± 3.8%; P <.001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8% vs 8.9%; P =.003) and conversion to atrial flutters (12.2% vs 5.4%; P =.02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95% confidence interval: 1.15–3.61; P =.015). Conclusion: PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.

Original languageEnglish (US)
Pages (from-to)1121-1129
Number of pages9
JournalHeart Rhythm
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2018

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Pulmonary Veins
Atrial Fibrillation
Cryosurgery
Cardiac Arrhythmias
Atrial Flutter

Keywords

  • Catheter ablation
  • Cryoablation
  • Cryoballoon
  • Persistent atrial fibrillation
  • Posterior wall isolation
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation : A multicenter experience. / Aryana, Arash; Baker, James H.; Espinosa Ginic, Martin A.; Pujara, Deep K.; Bowers, Mark R.; O'Neill, P. Gearoid; Ellenbogen, Kenneth A.; Di Biase, Luigi; d'Avila, André; Natale, Andrea.

In: Heart Rhythm, Vol. 15, No. 8, 01.08.2018, p. 1121-1129.

Research output: Contribution to journalArticle

Aryana, Arash ; Baker, James H. ; Espinosa Ginic, Martin A. ; Pujara, Deep K. ; Bowers, Mark R. ; O'Neill, P. Gearoid ; Ellenbogen, Kenneth A. ; Di Biase, Luigi ; d'Avila, André ; Natale, Andrea. / Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation : A multicenter experience. In: Heart Rhythm. 2018 ; Vol. 15, No. 8. pp. 1121-1129.
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abstract = "Background: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). Objective: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF). Methods: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9{\%}]) vs PVI alone (n = 168 [43.1{\%}]). Results: Acute isolation was achieved in 99.7{\%} of all pulmonary veins (PVI+PWI = 99.8{\%} vs PVI alone = 99.3{\%}; P =.23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8{\%} of patients to complete PVI (4 ± 2 minutes) and in 32.4{\%} to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2{\%} ± 6.4{\%} vs 40.6{\%} ± 4.9{\%}; P <.001) and total left atrial (53.3{\%} ± 4.2{\%} vs 36.3{\%} ± 3.8{\%}; P <.001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8{\%} vs 8.9{\%}; P =.003) and conversion to atrial flutters (12.2{\%} vs 5.4{\%}; P =.02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95{\%} confidence interval: 1.15–3.61; P =.015). Conclusion: PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.",
keywords = "Catheter ablation, Cryoablation, Cryoballoon, Persistent atrial fibrillation, Posterior wall isolation, Pulmonary vein isolation",
author = "Arash Aryana and Baker, {James H.} and {Espinosa Ginic}, {Martin A.} and Pujara, {Deep K.} and Bowers, {Mark R.} and O'Neill, {P. Gearoid} and Ellenbogen, {Kenneth A.} and {Di Biase}, Luigi and Andr{\'e} d'Avila and Andrea Natale",
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TY - JOUR

T1 - Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation

T2 - A multicenter experience

AU - Aryana, Arash

AU - Baker, James H.

AU - Espinosa Ginic, Martin A.

AU - Pujara, Deep K.

AU - Bowers, Mark R.

AU - O'Neill, P. Gearoid

AU - Ellenbogen, Kenneth A.

AU - Di Biase, Luigi

AU - d'Avila, André

AU - Natale, Andrea

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). Objective: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF). Methods: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9%]) vs PVI alone (n = 168 [43.1%]). Results: Acute isolation was achieved in 99.7% of all pulmonary veins (PVI+PWI = 99.8% vs PVI alone = 99.3%; P =.23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8% of patients to complete PVI (4 ± 2 minutes) and in 32.4% to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2% ± 6.4% vs 40.6% ± 4.9%; P <.001) and total left atrial (53.3% ± 4.2% vs 36.3% ± 3.8%; P <.001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8% vs 8.9%; P =.003) and conversion to atrial flutters (12.2% vs 5.4%; P =.02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95% confidence interval: 1.15–3.61; P =.015). Conclusion: PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.

AB - Background: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). Objective: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF). Methods: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9%]) vs PVI alone (n = 168 [43.1%]). Results: Acute isolation was achieved in 99.7% of all pulmonary veins (PVI+PWI = 99.8% vs PVI alone = 99.3%; P =.23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8% of patients to complete PVI (4 ± 2 minutes) and in 32.4% to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2% ± 6.4% vs 40.6% ± 4.9%; P <.001) and total left atrial (53.3% ± 4.2% vs 36.3% ± 3.8%; P <.001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8% vs 8.9%; P =.003) and conversion to atrial flutters (12.2% vs 5.4%; P =.02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95% confidence interval: 1.15–3.61; P =.015). Conclusion: PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.

KW - Catheter ablation

KW - Cryoablation

KW - Cryoballoon

KW - Persistent atrial fibrillation

KW - Posterior wall isolation

KW - Pulmonary vein isolation

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