학술논문
Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation.
Document Type
Academic Journal
Author
Yorgun H; Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.; Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands.; Şener YZ; Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.; Tanese N; Department of Cardiology, Clinique Pasteur, Toulouse, France.; Keresteci A; Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.; Sezenöz B; Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey.; Çöteli C; Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.; Ateş AH; Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.; Boveda S; Department of Cardiology, Clinique Pasteur, Toulouse, France.; Aytemir K; Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 100883649 Publication Model: Print Cited Medium: Internet ISSN: 1532-2092 (Electronic) Linking ISSN: 10995129 NLM ISO Abbreviation: Europace Subsets: MEDLINE
Subject
Language
English
Abstract
Aims: There is an increasing trend evaluating the role of non-pulmonary vein (PV) triggers to improve ablation outcomes in persistent atrial fibrillation (AF) as pulmonary vein isolation (PVI) strategy alone has modest outcomes. We investigated the long-term safety and efficacy of left atrial appendage isolation (LAAi) in addition to PVI using cryoballoon (CB) in persistent AF.
Methods and Results: In this multicentre retrospective analysis, we included a total of 193 persistent AF patients (mean age: 60 ± 11 years, 50.3% females) who underwent PVI and LAAi using CB. Baseline and follow-up data including electrocardiography (ECG), 24 h Holter ECGs, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a median follow-up of 55 (36.5-60.0) months, 85 (67.9%) patients with PVI + LAAi were in sinus rhythm after the index procedure. Ischaemic stroke/transient ischemic attack occurred in 14 (7.2%) patients at a median of 24 (2-53) months following catheter ablation. Multivariate regression analysis revealed heart failure with preserved ejection fraction [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.04-5.02; P = 0.038], male gender (HR 0.53, 95% CI 0.29-0.96; P = 0.037), and LA area (HR 1.04, 95% CI 0.53-1.32; P = 0.023) as independent predictors of ATa recurrence.
Conclusion: Our findings demonstrated that the LAAi + PVI strategy using CB had acceptable long-term outcomes in patients with persistent AF. Systemic thrombo-embolic events are an important concern throughout the follow-up, which were mostly observed in case of non-adherence to anticoagulants.
Competing Interests: Conflict of interest: H.Y. and K.A.: proctoring for Medtronic, Abbott, and Biosense Webster. S.B.: consultant for Medtronic, Boston Scientific, Microport, Zoll, BMS, and Pfizer. Y.Z.Ş., N.T., A.K., B.S., C.Ç., and A.H.A.: none.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Methods and Results: In this multicentre retrospective analysis, we included a total of 193 persistent AF patients (mean age: 60 ± 11 years, 50.3% females) who underwent PVI and LAAi using CB. Baseline and follow-up data including electrocardiography (ECG), 24 h Holter ECGs, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a median follow-up of 55 (36.5-60.0) months, 85 (67.9%) patients with PVI + LAAi were in sinus rhythm after the index procedure. Ischaemic stroke/transient ischemic attack occurred in 14 (7.2%) patients at a median of 24 (2-53) months following catheter ablation. Multivariate regression analysis revealed heart failure with preserved ejection fraction [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.04-5.02; P = 0.038], male gender (HR 0.53, 95% CI 0.29-0.96; P = 0.037), and LA area (HR 1.04, 95% CI 0.53-1.32; P = 0.023) as independent predictors of ATa recurrence.
Conclusion: Our findings demonstrated that the LAAi + PVI strategy using CB had acceptable long-term outcomes in patients with persistent AF. Systemic thrombo-embolic events are an important concern throughout the follow-up, which were mostly observed in case of non-adherence to anticoagulants.
Competing Interests: Conflict of interest: H.Y. and K.A.: proctoring for Medtronic, Abbott, and Biosense Webster. S.B.: consultant for Medtronic, Boston Scientific, Microport, Zoll, BMS, and Pfizer. Y.Z.Ş., N.T., A.K., B.S., C.Ç., and A.H.A.: none.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)