Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation in hemodialysis patients
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ORIGINAL ARTICLE
Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation in hemodialysis patients Tomomasa Takamiya1 · Junichi Nitta2 · Osamu Inaba1 · Akira Sato1 · Yukihiro Inamura1 · Nobutaka Kato3 · Kazuya Murata1 · Takashi Ikenouchi1 · Toshikazu Kono1 · Giichi Nitta1 · Yutaka Matsumura1 · Yoshihide Takahashi4 · Masahiko Goya4 · Tetsuo Sasano4 Received: 30 March 2020 / Accepted: 5 June 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Introduction Little evidence exists regarding cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (PAF) in hemodialysis (HD) patients. We compared CBA and radiofrequency ablation (RFA) of PAF in HD patients, referring to CBA of PAF in non-HD patients. Methods and results This historical cohort study examined 88 patients who underwent catheter ablation of PAF, including 21 HD patients with a second-generation 28-mm cryoballoon (CB-HD group), 17 HD patients with a non-force-sensing radiofrequency catheter (RF-HD group), and 50 non-HD patients with a cryoballoon (CB-non-HD group). Pulmonary vein (PV) isolation alone aside from cavotricuspid isthmus ablation was performed in 14 (67%) in the CB-HD group, 12 (71%) in the RF-HD group, and 36 (72%) in the CB-non-HD group (P = 0.95), without isoproterenol-induced non-PV triggers. Non-PV trigger ablation was added to the other patients. The Kaplan–Meier estimated 1-year freedom from atrial tachyarrhythmia recurrence without antiarrhythmic drugs after a single procedure was 76%, 59%, and, 92% in the CB-HD, RF-HD, and CB-non-HD groups, respectively (P = 0.002). The mean procedure time was shorter in the CB-HD group than in the RF-HD group (127 vs. 199 min; P 3 beats) were routinely targeted on ablation. When triggers from the left atrial posterior wall were identified, PWI was performed, creating a roof LA line and floor line. If SVC triggers were identified, SVC was electrically isolated. When non-PV triggers form other sites were identified, focal ablation was applied around the earliest ectopic site. If macroreentrant ATs were present, the mechanisms were determined by electroanatomical activation mapping or entrainment mapping, and linear ablation targeting the critical isthmus was performed.
PVI using CB ablation After a single transseptal puncture using an RF needle (Baylis Medical, Montreal, Canada) via an 8.5-Fr long sheath (SL0; Abbott, St. Paul, MN, USA), a 15-Fr steerable sheath (FlexCath; Medtronic, Inc., Minneapolis, MN, USA) was advanced into the LA over a guide wire. A 28-mm secondgeneration CB (Arctic Front Advance; Medtronic, Inc.) was advanced into the PV via the 15-Fr steerable sheath using a spiral 20-mm mapping catheter (Achieve; Medtronic, Inc.). The CB was inflated proximal to the PV ostium and pushed to achieve complete sealing at the antral aspect of the PV, which was verified using contrast medium. This was followed by CB application with a freeze cycle of 180–240 s. During CB applications of the right PVs, phrenic nerve pacing was performed using a 7-Fr circumferen
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