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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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Related in: MedlinePlus

Graphical representation of the overall 1-year clinical outcome after a mean of 1,2 procedures, presented as patient numbers. AF, recurrence of atrial fibrillation; AAD, anti-arrhythmic drugs.
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EUN218F4: Graphical representation of the overall 1-year clinical outcome after a mean of 1,2 procedures, presented as patient numbers. AF, recurrence of atrial fibrillation; AAD, anti-arrhythmic drugs.

Mentions: After one procedure, 49% (68/139) were free from AF without AADs. Of the remaining 51% (71/139) with AF recurrence, 27% (37/139) were advised to undergo a second procedure and 24% (34/139) continued on medical treatment due to a decrease in AF burden. In total, 34% (47/139) continued on medical treatment and 17% (24/139) agreed to undergo a second procedure. These data are represented in FigureĀ 4.


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)

Graphical representation of the overall 1-year clinical outcome after a mean of 1,2 procedures, presented as patient numbers. AF, recurrence of atrial fibrillation; AAD, anti-arrhythmic drugs.
© Copyright Policy
Related In: Results  -  Collection

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

EUN218F4: Graphical representation of the overall 1-year clinical outcome after a mean of 1,2 procedures, presented as patient numbers. AF, recurrence of atrial fibrillation; AAD, anti-arrhythmic drugs.
Mentions: After one procedure, 49% (68/139) were free from AF without AADs. Of the remaining 51% (71/139) with AF recurrence, 27% (37/139) were advised to undergo a second procedure and 24% (34/139) continued on medical treatment due to a decrease in AF burden. In total, 34% (47/139) continued on medical treatment and 17% (24/139) agreed to undergo a second procedure. These data are represented in FigureĀ 4.

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