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One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation.

Van Belle Y, Janse P, Theuns D, Szili-Torok T, Jordaens L - Europace (2008)

Bottom Line: All but one patient had successful PVI with a single procedure.No PV stenoses were observed.Temporary right phrenic nerve paralysis is the most important complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Clinical Electrophysiology Unit, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands. y.vanbelle@erasmusmc.nl

ABSTRACT

Aims: Pulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences.

Methods and results: Patients with symptomatic AF despite anti-arrhythmic drugs (AADs) were treated with cryoballoon PVI. Daily transtelephonic ECG monitoring, 24 h Holter-ECG, and an arrhythmia-focused questionnaire were used to document AF. One hundred and forty-one patients completed a follow-up of 457 +/- 252 days. Before ablation, Holter-ECG showed AF in 45%, including 16% continuous AF throughout the recording. Event recording revealed a median AF burden of 26%. The questionnaire showed a median of weekly AF complaints lasting for hours. All but one patient had successful PVI with a single procedure. After ablation, AF (defined as lasting for more than 30 s) was seen in 11% of Holter-ECGs, with 1% continuous AF. The event recording showed an AF burden of 9%. The median patient reported no more AF-related symptoms. Recurrence during the first 3 months was predictive for later recurrence. A second procedure was performed in 24 patients. The freedom of AF was 59% without AADs after 1,2 procedures. Four right phrenic nerve paralyses occurred, all resolving within 6 months. No PV stenoses were observed.

Conclusion: Pulmonary vein isolation with a cryothermal balloon is an effective treatment for paroxysmal AF, resulting in a clinical success rate comparable to studies involving radiofrequency ablation. Temporary right phrenic nerve paralysis is the most important complication.

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Atrial fibrillation (AF) burden as calculated from transtelephonic ECG recordings sorted ascendingly by the burden before pulmonary vein isolation (before) and burden sorted ascendingly after isolation (after). The area between both curves represents the reduction in AF burden for the entire group.
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EUN218F1: Atrial fibrillation (AF) burden as calculated from transtelephonic ECG recordings sorted ascendingly by the burden before pulmonary vein isolation (before) and burden sorted ascendingly after isolation (after). The area between both curves represents the reduction in AF burden for the entire group.

Mentions: A total number of 2019 rhythm strips before and 7986 after ablation were available, of which 534 of 2019 (26%) before and 686 of 7986 (9%) after ablation showed AF. Of the entire group, 119 patients had reliably transmitted transtelephonic rhythm strips before and after ablation. On average, they transmitted 17 ± 7 strips/month before ablation and 20 ± 9 strips/month after ablation. Of this group, 42 (35%) patients showed no AF episodes on the baseline event recording. Their AF burden before and after ablation is represented in Figure 1. The reduction in AF burden was highly significant (P < 0.0001) (Table 2). In total, 66 patients (55%) did not have any recurrence of AF after ablation on this event recording (P < 0.005). When looking at patients with recurrence, the AF burden still showed a significant reduction after ablation (P < 0.0001). The baseline burden between those with and without recurrence did not differ significantly.


One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation.

Van Belle Y, Janse P, Theuns D, Szili-Torok T, Jordaens L - Europace (2008)

Atrial fibrillation (AF) burden as calculated from transtelephonic ECG recordings sorted ascendingly by the burden before pulmonary vein isolation (before) and burden sorted ascendingly after isolation (after). The area between both curves represents the reduction in AF burden for the entire group.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2573029&req=5

EUN218F1: Atrial fibrillation (AF) burden as calculated from transtelephonic ECG recordings sorted ascendingly by the burden before pulmonary vein isolation (before) and burden sorted ascendingly after isolation (after). The area between both curves represents the reduction in AF burden for the entire group.
Mentions: A total number of 2019 rhythm strips before and 7986 after ablation were available, of which 534 of 2019 (26%) before and 686 of 7986 (9%) after ablation showed AF. Of the entire group, 119 patients had reliably transmitted transtelephonic rhythm strips before and after ablation. On average, they transmitted 17 ± 7 strips/month before ablation and 20 ± 9 strips/month after ablation. Of this group, 42 (35%) patients showed no AF episodes on the baseline event recording. Their AF burden before and after ablation is represented in Figure 1. The reduction in AF burden was highly significant (P < 0.0001) (Table 2). In total, 66 patients (55%) did not have any recurrence of AF after ablation on this event recording (P < 0.005). When looking at patients with recurrence, the AF burden still showed a significant reduction after ablation (P < 0.0001). The baseline burden between those with and without recurrence did not differ significantly.

Bottom Line: All but one patient had successful PVI with a single procedure.No PV stenoses were observed.Temporary right phrenic nerve paralysis is the most important complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Clinical Electrophysiology Unit, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands. y.vanbelle@erasmusmc.nl

ABSTRACT

Aims: Pulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences.

Methods and results: Patients with symptomatic AF despite anti-arrhythmic drugs (AADs) were treated with cryoballoon PVI. Daily transtelephonic ECG monitoring, 24 h Holter-ECG, and an arrhythmia-focused questionnaire were used to document AF. One hundred and forty-one patients completed a follow-up of 457 +/- 252 days. Before ablation, Holter-ECG showed AF in 45%, including 16% continuous AF throughout the recording. Event recording revealed a median AF burden of 26%. The questionnaire showed a median of weekly AF complaints lasting for hours. All but one patient had successful PVI with a single procedure. After ablation, AF (defined as lasting for more than 30 s) was seen in 11% of Holter-ECGs, with 1% continuous AF. The event recording showed an AF burden of 9%. The median patient reported no more AF-related symptoms. Recurrence during the first 3 months was predictive for later recurrence. A second procedure was performed in 24 patients. The freedom of AF was 59% without AADs after 1,2 procedures. Four right phrenic nerve paralyses occurred, all resolving within 6 months. No PV stenoses were observed.

Conclusion: Pulmonary vein isolation with a cryothermal balloon is an effective treatment for paroxysmal AF, resulting in a clinical success rate comparable to studies involving radiofrequency ablation. Temporary right phrenic nerve paralysis is the most important complication.

Show MeSH
Related in: MedlinePlus