Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation
The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-stand...
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| Veröffentlicht in: | JACC. Clinical electrophysiology 2021-02, Vol.7 (2), p.187-196 |
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| creator | Aryana, Arash Allen, Shelley L. Pujara, Deep K. Bowers, Mark R. O’Neill, Padraig Gearoid Yamauchi, Yasuteru Shigeta, Takatoshi Vierra, Eleanor C. Okishige, Kaoru Natale, Andrea |
| description | The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF).
Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation.
The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined.
Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p |
| doi_str_mv | 10.1016/j.jacep.2020.08.016 |
| format | Article |
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Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation.
The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined.
Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006).
In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
[Display omitted]</description><identifier>ISSN: 2405-500X</identifier><identifier>EISSN: 2405-5018</identifier><identifier>DOI: 10.1016/j.jacep.2020.08.016</identifier><identifier>PMID: 33602399</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>catheter ablation ; cryoballoon ; persistent atrial fibrillation ; posterior wall isolation ; pulmonary vein isolation</subject><ispartof>JACC. Clinical electrophysiology, 2021-02, Vol.7 (2), p.187-196</ispartof><rights>2021 American College of Cardiology Foundation</rights><rights>Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-3aeec3eb667503803859501cd602b8129fafa207c0e116a99f1e52f16a6195773</citedby><cites>FETCH-LOGICAL-c404t-3aeec3eb667503803859501cd602b8129fafa207c0e116a99f1e52f16a6195773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33602399$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aryana, Arash</creatorcontrib><creatorcontrib>Allen, Shelley L.</creatorcontrib><creatorcontrib>Pujara, Deep K.</creatorcontrib><creatorcontrib>Bowers, Mark R.</creatorcontrib><creatorcontrib>O’Neill, Padraig Gearoid</creatorcontrib><creatorcontrib>Yamauchi, Yasuteru</creatorcontrib><creatorcontrib>Shigeta, Takatoshi</creatorcontrib><creatorcontrib>Vierra, Eleanor C.</creatorcontrib><creatorcontrib>Okishige, Kaoru</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><title>Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation</title><title>JACC. Clinical electrophysiology</title><addtitle>JACC Clin Electrophysiol</addtitle><description>The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF).
Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation.
The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined.
Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006).
In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
[Display omitted]</description><subject>catheter ablation</subject><subject>cryoballoon</subject><subject>persistent atrial fibrillation</subject><subject>posterior wall isolation</subject><subject>pulmonary vein isolation</subject><issn>2405-500X</issn><issn>2405-5018</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9UU1r3DAQFaWlCWl-QaHo2Mu6I_ljrUMPy9K0gUCXkI_ehCyPWxlb2kpyYH9B_3Yn3TTHgEDDzJv3ZuYx9l5AIUA0n8ZiNBb3hQQJBbQF5V6xU1lBvapBtK-fY_hxws5TGgFA1LKVonrLTsqyAVkqdcr-bIO3YXbZ-Mx3yzQHb-KB36Hz3Pie70LKGF2I_N5ME79MYTLZBc9vk_M_-TYeQkeFQJl7l3_xTT8u3mZ-bXoXhoi_F_T2wIlthzE5IiOdTY7OTPzCddFNR7537M1gpoTnT_8Zu734crP9trr6_vVyu7la2QqqvCoNoi2xa5p1DWVLr1a0r-1pn64VUg1mMBLWFlCIxig1CKzlQGEjVL1el2fs45F3HwPNlrKeXbJIU3gMS9KyUkJVRCQIWh6hNoaUIg56H91M19EC9KMJetT_TNCPJmhoNeWo68OTwNLN2D_3_D85AT4fAUhrPjiMOllHR8LeRbRZ98G9KPAXkOeawQ</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Aryana, Arash</creator><creator>Allen, Shelley L.</creator><creator>Pujara, Deep K.</creator><creator>Bowers, Mark R.</creator><creator>O’Neill, Padraig Gearoid</creator><creator>Yamauchi, Yasuteru</creator><creator>Shigeta, Takatoshi</creator><creator>Vierra, Eleanor C.</creator><creator>Okishige, Kaoru</creator><creator>Natale, Andrea</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202102</creationdate><title>Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation</title><author>Aryana, Arash ; Allen, Shelley L. ; Pujara, Deep K. ; Bowers, Mark R. ; O’Neill, Padraig Gearoid ; Yamauchi, Yasuteru ; Shigeta, Takatoshi ; Vierra, Eleanor C. ; Okishige, Kaoru ; Natale, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-3aeec3eb667503803859501cd602b8129fafa207c0e116a99f1e52f16a6195773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>catheter ablation</topic><topic>cryoballoon</topic><topic>persistent atrial fibrillation</topic><topic>posterior wall isolation</topic><topic>pulmonary vein isolation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aryana, Arash</creatorcontrib><creatorcontrib>Allen, Shelley L.</creatorcontrib><creatorcontrib>Pujara, Deep K.</creatorcontrib><creatorcontrib>Bowers, Mark R.</creatorcontrib><creatorcontrib>O’Neill, Padraig Gearoid</creatorcontrib><creatorcontrib>Yamauchi, Yasuteru</creatorcontrib><creatorcontrib>Shigeta, Takatoshi</creatorcontrib><creatorcontrib>Vierra, Eleanor C.</creatorcontrib><creatorcontrib>Okishige, Kaoru</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aryana, Arash</au><au>Allen, Shelley L.</au><au>Pujara, Deep K.</au><au>Bowers, Mark R.</au><au>O’Neill, Padraig Gearoid</au><au>Yamauchi, Yasuteru</au><au>Shigeta, Takatoshi</au><au>Vierra, Eleanor C.</au><au>Okishige, Kaoru</au><au>Natale, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation</atitle><jtitle>JACC. Clinical electrophysiology</jtitle><addtitle>JACC Clin Electrophysiol</addtitle><date>2021-02</date><risdate>2021</risdate><volume>7</volume><issue>2</issue><spage>187</spage><epage>196</epage><pages>187-196</pages><issn>2405-500X</issn><eissn>2405-5018</eissn><abstract>The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF).
Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation.
The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined.
Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006).
In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | catheter ablation cryoballoon persistent atrial fibrillation posterior wall isolation pulmonary vein isolation |
| title | Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation |
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