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Cryoballoon supplement to pulmonary-vein isolation curbs AF recurrence

JACC: Clinical Electrophysiology
Reuters Health - 06/11/2020 - In patients with long-standing persistent recurrence of atrial fibrillation (AF), pulmonary-vein isolation (PVI) with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon suppresses AF recurrence more effectively than does PVI alone, according to U.S. and Japanese researchers.

Although studies have suggested this approach could be successful, there is limited information on its efficacy when using cryoballoon ablation, Dr. Arash Aryana of Mercy General Hospital and Dignity Health Heart and Vascular Institute, in Sacramento, California, and colleagues note in JACC: Clinical Electrophysiology.

To investigate, the researchers studied 110 patients who underwent PVI requiring a mean of 23 minutes of cryoablation. Adjunct radiofrequency ablation was required in four of the patients (7.3%) to complete PVI.

The patients were then randomized to PVI or PVI plus PWI. If not in sinus rhythm, the PVI group underwent cardioversion. The other group underwent PWI within the region of the pulmonary-vein component using the cryoballoon. Adjunct radiofrequency ablation was required in 25 (45.5%) of these patients.

Although left atrial dwell time, and total procedure time were longer in the PVI+PWI group they required significantly fewer intraprocedural cardioversions. Adverse events were seen in three patients in each group (5.5%).

Patients were discharged from the hospital within one day of the procedure. Oral anticoagulation was resumed and continued for a minimum of three months. Antiarrhythmic therapy was discontinued within three months and mortality at three months was zero.

At 12 months of follow-up there was no difference in the recurrence of atrial flutter or tachycardia between PVI+PWI and PVI alone groups. However, the incidence of recurrent atrial fibrillation was significantly lower with PVI+PWI than with PVI alone (25.5% vs. 45.5%, P=0.028).

Thus, the researchers conclude, "PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone."

Several of the authors report financial ties to Medtronic, which sells the cryoballoon and related equipment used in the study.

Dr. Aryana did not respond to requests for comments.

By Reuters Staff

SOURCE: https://bit.ly/3eu0tpZ JACC: Clinical Electrophysiology, online October 28, 2020.

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