Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: A comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation

Giuseppe Ciconte, Giannis Baltogiannis, Carlo De Asmundis, Juan Sieira, Giulio Conte, Giacomo Di Giovanni, Yukio Saitoh, Ghazala Irfan, Giacomo Mugnai, Burak Hunuk, Gian Battista Chierchia, Pedro Brugada

Research output: Contribution to journalArticle

Abstract

Aims To assess the 1 year efficacy of pulmonary vein isolation (PVI) as index procedure for persistent atrial fibrillation (PersAF) comparing conventional radiofrequency irrigated-tip catheter ablation (RFCA) using contact-force technology and ablation using the second-generation cryoballoon (CB-AdvA). Methods and results One hundred consecutive patients (74 male, 74%; mean age 62.4 ± 9.6 years) with drug-refractory PersAF undergoing PVI using RFCA and CB-AdvA were enrolled. Follow-up was based on outpatient clinic visits including Holter-electrocardiograms. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 s. Among 100 patients, 50 underwent RFCA whereas 50 CB-AdvA. Mean procedure and fluoroscopy times were 90.5 ± 41.7 vs. 140.2 ± 46.9 min and 14.5 ± 6.6 vs. 19.8 ± 6.8 min in the CB-Adv and in the RFCA group, respectively (P <0.01). At 1 year follow-up, after a 3 months blanking period (BP), freedom from ATas off-drugs after a single procedure was 60% (28/50 patients) in the CB-Adv and 56% (27/50 patients) in the RFCA group (P = 0.71). Multivariate analysis demonstrated that PersAF duration (P = 0.01) and relapses during BP (P = 0.02) were independent predictors of ATa recurrences following the index procedure. Conclusion Freedom from ATas following PersAF ablation with RFCA and CB-Adv is comparable at 1 year follow-up after a single procedure. Ablation with the CB-Adv is associated with shorter procedure time and radiation exposure as compared with RFCA. Atrial tachyarrhythmias occurrence during BP and longer time of PersAF seem to be significant predictors of arrhythmia recurrences after the index procedure.

Original languageEnglish
Pages (from-to)559-565
Number of pages7
JournalEuropace
Volume17
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

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Keywords

  • Cryoballoon ablation
  • One year follow-up
  • Persistent atrial fibrillation
  • Pulmonary vein isolation
  • Radiofrequency catheter ablation
  • Second generation cryoballoon

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Ciconte, G., Baltogiannis, G., De Asmundis, C., Sieira, J., Conte, G., Di Giovanni, G., Saitoh, Y., Irfan, G., Mugnai, G., Hunuk, B., Chierchia, G. B., & Brugada, P. (2015). Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: A comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation. Europace, 17(4), 559-565. https://doi.org/10.1093/europace/euu350