Clinical Research in Cardiology

, Volume 107, Issue 7, pp 570–577 | Cite as

Safety and efficacy of persistent atrial fibrillation ablation using the second-generation cryoballoon

  • Kivanc Yalin
  • Amr Abdin
  • Evgeny Lyan
  • Noureddin Sawan
  • Spyridon Liosis
  • Christian Elsner
  • Alexander Jobs
  • Ben Brüggemann
  • Jelena Koester
  • Ingo Eitel
  • Charlotte Eitel
  • Roland Richard Tilz
Original Paper
  • 110 Downloads

Abstract

Background

The second-generation cryoballoon (CB) is increasingly used for treatment of persistent atrial fibrillation (AF). Data regarding the clinical outcome and mechanism of arrhythmia recurrence following persistent AF ablation using CB is sparse. In this study, we aimed to assess the efficacy of CB and mechanisms of atrial tachyarrhythmia (ATA) recurrence in patients with persistent AF.

Methods and results

A total of 133 patients (66 ± 10 years, 60% male) with symptomatic persistent AF, who were scheduled for PVI using the second-generation CB were enrolled. Follow-up included 24 h Holter recording at 3, 6 and 12 months. Any documented episode of ATA lasting more than 30 s was considered as a recurrent arrhythmic event. All targeted veins were isolated (100%). Phrenic nerve palsy with recovery during follow-up occurred in six patients (4.5%), no patient experienced tamponade or a cerebrovascular event. During 12.6 ± 5.4 months of follow-up, 89/133 (67%) patients were free of ATA recurrences. Multivariable analysis revealed recurrence in the blanking period (HR 11.46, 0.95 CI 3.92–33.49, p < 0.001), presence of cardiomyopathy (HR 2.75, 0.95 CI 1.09–6.96, p = 0.032) and PV abnormality (HR 3.56, 0.95 CI 1.21–10.43, p = 0.021) as predictors for late recurrence.

Conclusion

In patients with persistent AF, second-generation cryoballoon use is associated with an excellent safety profile and favorable outcomes. Arrhythmia recurrence during the blanking period, presence of cardiomyopathy and PV abnormality were independent predictors of long-term AF recurrence.

Keywords

Persistent atrial fibrillation Cryoballoon ablation 

Abbreviations

ATA

Atrial tachyarrhythmia

AF

Atrial fibrillation

CB

Cryoballoon

CMP

Cardiomyopathy

CTI

Cavotricuspid isthmus

EHRA

European Heart Rhythm Association

ICD

Implantable cardioverter defibrillator

INR

International normalized ratio

LA

Left atrium

LCPV

Left common pulmonary vein

LIPV

Left inferior pulmonary vein

LSPV

Left superior pulmonary vein

LVEF

Left ventricular ejection fraction

PM

Pacemaker

PNP

Phrenic nerve palsy

PV

Pulmonary vein

PVI

Pulmonary vein isolation

RIPV

Right inferior pulmonary vein

RMPV

Right middle pulmonary vein

RSPV

Right superior pulmonary vein

RF

Radiofrequency

SR

Sinus rhythm

Notes

Acknowledgements

K. Yalin recieved research and educational grant from Turkish Society of Cardiology. E. Lyan received travel grants and Speaker’s Bureau Honoraria from Biosense Webster, Medtronic, Boston Scientific. R. Tilz received travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi Sankyo, Sentrheart and Speaker’s Bureau Honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sanofi Aventis.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kivanc Yalin
    • 1
    • 2
  • Amr Abdin
    • 1
  • Evgeny Lyan
    • 1
  • Noureddin Sawan
    • 1
  • Spyridon Liosis
    • 1
  • Christian Elsner
    • 1
  • Alexander Jobs
    • 1
  • Ben Brüggemann
    • 1
  • Jelena Koester
    • 1
  • Ingo Eitel
    • 1
  • Charlotte Eitel
    • 1
  • Roland Richard Tilz
    • 1
  1. 1.Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic IIUniversity Hospital Schleswig-HolsteinLuebeckGermany
  2. 2.Department of Cardiology, Faculty of MedicineUsak UniversityUsakTurkey

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