Limits...
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.

Show MeSH

Related in: MedlinePlus

Event-free survival curve for atrial fibrillation (AF) after a single ablation procedure, employing 3-month blanking period. The upper curve (no early recurrence) is the patient population that did not have recurrence of AF during the blanking period. The lower curve (with early recurrence) represents the group that experienced recurrence of AF during the 3-month blanking period. Patient numbers of both groups are represented at the bottom.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2573029&req=5

EUN218F3: Event-free survival curve for atrial fibrillation (AF) after a single ablation procedure, employing 3-month blanking period. The upper curve (no early recurrence) is the patient population that did not have recurrence of AF during the blanking period. The lower curve (with early recurrence) represents the group that experienced recurrence of AF during the 3-month blanking period. Patient numbers of both groups are represented at the bottom.

Mentions: Combining all these resources, actuarial event-free rates from any AF were calculated (Figure 2). The event-free survival rate at 365 days was 44%. When all events in the first 3 months were blanked, and the curve was constructed from 90 days on, the event-free survival rate at 365 days was 73% (P < 0.0001). When patients with and without a recurrence in the first 3 months were compared (Figure 3), it became clear that a recurrence in the first 3 months was highly predictive for recurrence after 3 months, whereas the absence of events in the first 3 months was highly predictive for a low recurrence rate (log-rank 23, P < 0.0001).


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)

Event-free survival curve for atrial fibrillation (AF) after a single ablation procedure, employing 3-month blanking period. The upper curve (no early recurrence) is the patient population that did not have recurrence of AF during the blanking period. The lower curve (with early recurrence) represents the group that experienced recurrence of AF during the 3-month blanking period. Patient numbers of both groups are represented at the bottom.
© Copyright Policy
Related In: Results  -  Collection

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

EUN218F3: Event-free survival curve for atrial fibrillation (AF) after a single ablation procedure, employing 3-month blanking period. The upper curve (no early recurrence) is the patient population that did not have recurrence of AF during the blanking period. The lower curve (with early recurrence) represents the group that experienced recurrence of AF during the 3-month blanking period. Patient numbers of both groups are represented at the bottom.
Mentions: Combining all these resources, actuarial event-free rates from any AF were calculated (Figure 2). The event-free survival rate at 365 days was 44%. When all events in the first 3 months were blanked, and the curve was constructed from 90 days on, the event-free survival rate at 365 days was 73% (P < 0.0001). When patients with and without a recurrence in the first 3 months were compared (Figure 3), it became clear that a recurrence in the first 3 months was highly predictive for recurrence after 3 months, whereas the absence of events in the first 3 months was highly predictive for a low recurrence rate (log-rank 23, P < 0.0001).

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