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Multicenter Study
. 2023 Feb 16;25(2):366-373.
doi: 10.1093/europace/euac167.

Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation

Hikmet Yorgun  1   2 , Yusuf Ziya Şener  1 , Nikita Tanese  3 , Ahmet Keresteci  1 , Burak Sezenöz  4 , Cem Çöteli  1 , Ahmet Hakan Ateş  1 , Serge Boveda  3 , Kudret Aytemir  1
Affiliations
Multicenter Study

Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation

Hikmet Yorgun et al. Europace. .

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.

Keywords: Atrial fibrillation; Cryoballoon; Left atrial appendage isolation; Pulmonary vein isolation.

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Conflict of interest statement

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.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Kaplan–Meier analysis illustrating freedom from TIA/stroke (92.8%) strategies during the median follow-up of 55 (36.5–60.0) months.
Figure 2
Figure 2
Kaplan–Meier analysis illustrating freedom from ATa after PVI + LAAi approach during the median follow-up of 55 (36.5–60.0) months after exclusion of blanking period (90 days after ablation). AT, atrial tachycardia.
See this image and copyright information in PMC

References

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