Long-term durability of posterior wall isolation using the cryoballoon in patients with persistent atrial fibrillation:
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Long-term durability of posterior wall isolation using the cryoballoon in patients with persistent atrial fibrillation: a multicenter analysis of repeat catheter ablations Arash Aryana 1 & Luigi Di Biase 2 & Deep K. Pujara 3 & James H. Baker 4 & Martin A. Espinosa 4 & Carlo de Asmundis 5 & Mark R. Bowers 1 & Padraig Gearoid O’Neill 1 & Kenneth A. Ellenbogen 6 & Pedro Brugada 5 & Gian-Battista Chierchia 5 & André d’Avila 7 & Andrea Natale 8 Received: 18 July 2020 / Accepted: 24 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose There is a growing interest in performing pulmonary vein isolation (PVI) with concomitant posterior wall isolation (PWI) using the cryoballoon for the treatment of patients with persistent atrial fibrillation (AF). However, there is little known about the long-term durability of PWI using this approach. Methods In this multicenter study, we retrospectively examined the durability of PVI + PWI using the 28-mm cryoballoon by investigating the outcomes from consecutive patients referred for repeat catheter ablation. Results Altogether, 81/519 patients (15.6%) were referred for repeat catheter ablation. Repeat ablation was associated with a longer AF duration, hypertension, heart failure, multiple cardioversions, and antiarrhythmic therapy as well as larger left atrial (LA) diameters (49 ± 4 mm versus 43 ± 5 mm; P < 0.001) and greater need for “touch-up” (adjunct) radiofrequency ablation (44.4% versus 18.3%; P < 0.001). LA diameter also emerged as a significant predictor for adjunct radiofrequency ablation (P < 0.001). Durable PVI was observed in 66/81 patients (81.5%) and PWI in 67/81 patients (82.7%). Those with incomplete PWI exhibited larger LA diameters, particularly > 48 mm (negative predictive value = 89.7%). Lastly, an atypical LA posterior wall/roof flutter represented the third most common cause of arrhythmia recurrence and essentially every patient with incomplete PWI exhibited such an arrhythmia. Conclusion PWI performed using a 28-mm cryoballoon in conjunction with PVI exhibits long-term durability in the vast majority of patients with persistent AF. While LA diameter (particularly > 48 mm) is a significant predictor for the need for adjunct radiofrequency ablation when performing this technique, those with incomplete PWI invariably present with an atypical flutter using this substrate. Keywords Catheter ablation . Cryoablation . Cryoballoon . Persistent atrial fibrillation . Pulmonary vein isolation . Posterior wall isolation
1 Introduction Although pulmonary vein (PV) isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation [1], the success
* Arash Aryana [email protected] 1
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rate associated with PVI alone in patients with persistent AF remains low [2]. Several studies [3, 4] have shown a benefit associated with PVI and concomitant isolation of the left atrial (LA) posterior wall (PW) lying between the PVs—the so-
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Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and P
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