Comparison of Advanced Generation Cryoballoon Ablation and Ablation Index-guided Pulmonary Vein Isolation with Non-pulmonary Vein Trigger Induction Test and Additional Ablation in Paroxysmal Atrial Fibrillation

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2022 Dec 27

PMID 36575227

Authors

Yasuyuki Egami

Masami Nishino

Hiroaki Nohara

Shodai Kawanami

Hiroki Sugae

Kohei Ukita

Akito Kawamura

Hitoshi Nakamura

Koji Yasumoto

Masaki Tsuda

Naotaka Okamoto

Yasuharu Matsunaga-Lee

Masamichi Yano

Jun Tanouchi

Affiliations

Soon will be listed here.

Abstract

Background: An ablation index (AI)-guided pulmonary vein isolation (PVI) or 2nd generation cryoballoon (CB)-PVI has been shown to reduce the atrial fibrillation (AF) burden by 99% despite the absence of ablation of non-pulmonary vein (PV) triggers in patients with paroxysmal AF. The purpose of this study was to investigate the effects of PVI alone strategy using 2nd generation CB compared with AI-guided PVI with an additional induction test and subsequent AF trigger ablation.

Methods And Results: We investigated 223 patients with symptomatic paroxysmal AF who underwent an initial PVI between August 2018 and August 2020. The study patients were divided into 2 groups: CB-PVI without an induction test (CB-PVI alone group, n = 82) and AI-guided PVI with an induction test and subsequent additional ablation of non-PV triggers (AI-PVI plus group, n = 141). In the AI-PVI plus group, a total of 62 non-PV triggers were induced in 38 patients, and non-PV triggers in 22 patients were completely ablated. The procedure time and left atrium dwell time were significantly shorter in the CB-PVI alone group than AI-PVI plus group. There were no significant differences in the incidence of procedural complications between the 2 groups (P = 0.650). The AF free survival rate in the CB-PVI alone group and AI-PVI plus group was 80% vs. 80% at 24 months (P = 0.969).

Conclusions: An PVI alone strategy using advanced generation CB did not differ in the clinical outcomes compared with an AI-guided PVI strategy with an induction test and subsequent ablation of non-PV triggers in the patients with paroxysmal AF.

References

Fuster V, Ryden L, Cannom D, Crijns H, Curtis A, Ellenbogen K . ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for.... Circulation. 2006; 114(7):e257-354. DOI: 10.1161/CIRCULATIONAHA.106.177292. View

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

Zhao Y, Di Biase L, Trivedi C, Mohanty S, Bai R, Mohanty P . Importance of non-pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction. Heart Rhythm. 2015; 13(1):141-9. DOI: 10.1016/j.hrthm.2015.08.029. View

Kato N, Nitta J, Sato A, Inamura Y, Takamiya T, Inaba O . Characteristics of the nonpulmonary vein foci induced after second-generation cryoballoon ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2019; 31(1):174-184. DOI: 10.1111/jce.14314. View

Chang H, Lo L, Lin Y, Chang S, Hu Y, Li C . Long-term outcome of catheter ablation in patients with atrial fibrillation originating from nonpulmonary vein ectopy. J Cardiovasc Electrophysiol. 2012; 24(3):250-8. DOI: 10.1111/jce.12036. View

Takigawa M, Takahashi A, Kuwahara T, Okubo K, Takahashi Y, Nakashima E . Impact of Non-Pulmonary Vein Foci on the Outcome of the Second Session of Catheter Ablation for Paroxysmal Atrial Fibrillation. J Cardiovasc Electrophysiol. 2015; 26(7):739-46. DOI: 10.1111/jce.12681. View

Sorensen S, Johannessen A, Worck R, Hansen M, Hansen J . Radiofrequency Versus Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation: Durability of Pulmonary Vein Isolation and Effect on Atrial Fibrillation Burden: The RACE-AF Randomized Controlled Trial. Circ Arrhythm Electrophysiol. 2021; 14(5):e009573. PMC: 8136462. DOI: 10.1161/CIRCEP.120.009573. View

Matsunaga-Lee Y, Takano Y . A novel mapping technique to detect non-pulmonary vein triggers: A case report of self-reference mapping technique. HeartRhythm Case Rep. 2018; 4(1):26-28. PMC: 5775448. DOI: 10.1016/j.hrcr.2017.10.015. View

Ciconte G, Baltogiannis G, de Asmundis C, Sieira J, Conte G, di Giovanni G . Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation. Europace. 2015; 17(4):559-65. DOI: 10.1093/europace/euu350. View

10.

Gupta A, Perera T, Ganesan A, Sullivan T, Lau D, Roberts-Thomson K . Complications of catheter ablation of atrial fibrillation: a systematic review. Circ Arrhythm Electrophysiol. 2013; 6(6):1082-8. DOI: 10.1161/CIRCEP.113.000768. View

11.

Inamura Y, Nitta J, Inaba O, Kono T, Ikenouchi T, Murata K . Differences in the electrophysiological findings of repeat ablation between patients who first underwent cryoballoon ablation and radiofrequency catheter ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2019; 30(10):1792-1800. DOI: 10.1111/jce.14065. View

12.

De Pooter J, Strisciuglio T, El Haddad M, Wolf M, Phlips T, Vandekerckhove Y . Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients After a Single Pulmonary Vein Isolation Procedure. JACC Clin Electrophysiol. 2019; 5(3):295-305. DOI: 10.1016/j.jacep.2018.11.020. View

13.

Garabelli P, Stavrakis S, Kenney J, Po S . Effect of 28-mm Cryoballoon Ablation on Major Atrial Ganglionated Plexi. JACC Clin Electrophysiol. 2018; 4(6):831-838. DOI: 10.1016/j.jacep.2017.12.016. View