Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 28;37(5):1303-1310.
doi: 10.1002/joa3.12626. eCollection 2021 Oct.

Preventing atrial fibrillation by combined right isthmus ablation and cryoballoon pulmonary vein isolation in patients with typical atrial flutter: PAF-CRIOBLAF study

Frédéric Anselme  1 , Arnaud Savouré  1 , Nicolas Clémenty  2 , Olivier Cesari  3 , Dominique Pavin  4 , Laurence Jesel  5 , Pascal Defaye  6 , Serge Boveda  7 , Philippe Rivat  8 , Jacques Mansourati  9 , Alexis Mechulan  10 , Jean-Pierre Cebron  11 , Gilles Lande  12 , Michael Bubenheim ScD  13 , Antoine Milhem  14
Affiliations

Preventing atrial fibrillation by combined right isthmus ablation and cryoballoon pulmonary vein isolation in patients with typical atrial flutter: PAF-CRIOBLAF study

Frédéric Anselme et al. J Arrhythm. .

Abstract

Background: Although less common, typical atrial flutter shares similar pathophysiological roots with atrial fibrillation. Following successful cavo-tricuspid isthmus ablation using radiofrequency, many patients, however, develop atrial fibrillation in the mid-to-long-term. This study sought to assess whether pulmonary vein isolation conducted at the same time as cavo-tricuspid isthmus ablation would significantly modify the atrial fibrillation burden upon follow-up in patients suffering from typical atrial flutter.

Methods: This was a multicenter randomized controlled study involving typical atrial flutter patients with history of non-predominant atrial fibrillation (1 atrial fibrillation episode only, in 67% of population) who were scheduled for cavo-tricuspid isthmus radiofrequency ablation. Patients were randomly assigned to either undergo cavo-tricuspid isthmus ablation alone or cavo-tricuspid isthmus plus pulmonary vein isolation (CTI+). Pulmonary vein isolation was performed using cryoballoon technology. An outpatient consultation with ECG and 1-week Holter monitoring was performed at 3, 6 months, 1 year, and 2 years postprocedure. The primary endpoint was atrial fibrillation recurrences lasting more than 30 s at 2 years postablation.

Results: Of the patients enrolled, 36 were included in each group. At 2-year follow-up, the atrial fibrillation recurrence rate was significantly higher in the CTI vs CTI+group (25/36, 69% vs. 12/36, 33% respectively; P < .001), with similar typical atrial flutter recurrence rates. There were no differences in undesirable events, except for transient phrenic nerve palsy reported from three CTI+patients (8.3%).

Conclusion: Pulmonary vein isolation using cryoballoon technology was proven to significantly reduce the atrial fibrillation incidence at 2 years postcavo-tricuspid isthmus ablation.

Keywords: ablation techniques; atrial fibrillation; atrial flutter; cryoablation; pulmonary veins.

PubMed Disclaimer

Conflict of interest statement

FA is consultant for and received lecture fees from Boston Scientific, Medtronic, and Microport CRM. AS received honoraria from Microport CRM. NC is consultant for and received lecture fees from Medtronic. PD received research grants and honoraria from Boston Scientific, Abbott, Microport CRM, and Medtronic. SB is consultant for Medtronic, Boston Scientific, Microport CRM, and Zoll. The other authors declare no conflicts of interest. The protocol for this research has been approved by a suitable constituted Ethics Committee of the institution under the approval number 2011‐A00806‐35, on July 21, 2011 and it conforms to the provisions of the Declaration of Helsinki. The ClinicalTrial identifier of this study is NCT01521988

Figures

FIGURE 1
FIGURE 1
Survival curves regarding atrial fibrillation recurrences during follow‐up
See this image and copyright information in PMC

References

    1. Cauchemez B, Haissaguerre M, Fischer B, Thomas O, Clementy J, Coumel P. Electrophysiological effects of catheter ablation of inferior vena cava‐tricuspid annulus isthmus in common atrial flutter. Circulation. 1996;93(2):284–94. - PubMed
    1. Pérez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA. Long‐term outcomes after catheter ablation of cavo‐tricuspid isthmus dependent atrial flutter: a meta‐analysis. Circ Arrhythm Electrophysiol. 2009;2(4):393–401. - PubMed
    1. Bertaglia E, Zoppo F, Bonso A, Proclemer A, Verlato R, Corò L, et al. Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence. Heart. 2004;90(1):59–63. - PMC - PubMed
    1. Da Costa A, Romeyer C, Mourot S, Messier M, Cerisier A, Faure E, et al. Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study. Eur Heart J. 2002;23(6):498–506. - PubMed
    1. Linhart M, Bellmann B, Mittmann‐Braun E, Schrickel JW, Bitzen A, Andrié R, et al. Comparison of cryoballoon and radiofrequency ablation of pulmonary veins in 40 patients with paroxysmal atrial fibrillation: a case‐control study. J Cardiovasc Electrophysiol. 2009;20(12):1343–8. - PubMed