Abstract
Objective
We analyzed the medium-term follow-up of cryoballoon ablation (CBA) for atrial fibrillation (AF) and the clinical risk factors predicting outcome.
Methods
AF patients treated for the first time with CBA in a 4.5-year period were studied retrospectively. Pulmonary vein isolation (PVI) was achieved via a single cryoballoon with diameter of 28 mm. Left atrial diameter (LAD) was measured by transthoracic echocardiography. Failure of cryoablation treatment was defined as detection of an episode of AF, atrial flutter, or atrial tachycardia lasting more than 30 s during the 3-month follow-up.
Results
A total of 212 patients were enrolled and in 87.7 % patients PVI was achieved by CBA. The complication rate was 2.83 %. The mean follow-up was 28 ± 15 months; in 166 patients follow-up was complete. The rate of successful treatment for primary CBA was 45.8 %. The percentage of patients who experienced atrial arrhythmia recurrence in the first 12 months was 84.44 %. Patients in whom treatment failed had a larger LAD (47 ± 6 mm vs. 43 ± 5 mm, p < 0.0001). The Kaplan–Meier curve showed that the patients with LAD < 45 mm had a higher success rate than patients with LAD ≥ 45 mm [57.9 % (44/76) vs. 35.6 % (32/90), log rank = 5.492, p = 0.019]. The LAD [odds ratio, OR = − 0.1053(0.303, 12.2040), p = 0.0005] was shown in logistic regression analysis to be independently predictive of CBA treatment failure.
Conclusion
The CBA procedure for AF patients is safe and effective. Most atrial arrhythmia recurrences occurred during the first 12 months after CBA. The LAD can independently predict failure of CBA treatment.
Zusammenfassung
Ziel
Untersucht wurden der mittelfristige Verlauf nach Kyroballonablation (CBA) bei Vorhofflimmern (VF) und die klinischen Risikofaktoren, die das Ergebnis prognostizieren.
Methoden
Retrospektiv untersucht wurden VF-Patienten, bei denen erstmals in einem 4,5-Jahres-Zeitraum eine CBA erfolgte. Die Pulmonalvenenisolation (PVI) wurde mittels eines einzelnen Kryoballons mit einem Durchmesser von 28 mm erzielt. Der linksatriale Durchmesser (LAD) wurde transthorakal echokardiographisch gemessen. Das Versagen der Kryoablationstherapie war definiert durch den Nachweis einer Phase von VF, Vorhofflattern oder Vorhoftachkardie mit einer Dauer > 30 s während des 3-monatigen Follow-up.
Ergebnisse
In die Studie aufgenommen wurden 212 Patienten, und bei 87,7 % wurde eine PVI per CBA erzielt. Die Komplikationsrate betrug 2,83 %. Das durchschnittliche Follow-up lag bei 28 ± 15 Monaten; bei 166 Patienten wurde es vollständig durchgeführt. Die Therapieerfolgsrate der primären CBA betrug 45,8 %. Der Anteil der Patienten, bei denen es in den ersten 12 Monaten zu einem Rezidiv der Vorhofarrhythmie kam, lag bei 84,44 %. Patienten mit Therapieversagen wiesen einen größeren LAD auf (47 ± 6 mm vs. 43 ± 5 mm; p < 0,0001). Die Kaplan-Meier-Kurve zeigte, dass bei Patienten mit einem LAD < 45 mm die Erfolgsrate höher war als Patienten mit einem LAD ≥ 45 mm [57,9 % (44/76) vs. 35,6 % (32/90), Log Rank = 5,492; p = 0,019]. Die LAD [Odds Ratio, OR = − 0,1053 (0,303; 12,2040), p = 0,0005] erwies sich in der logistischen Regressionsanalyse als unabhängiger Prädiktor des Therapieversagens der CBA.
Schlussfolgerung
Das Verfahren der CBA bei Patienten mit VF ist sicher und wirksam. Die meisten Rezidive im Hinblick auf Vorhofarrhythmien traten in den ersten 12 Monaten nach CBA auf. Der LAD ist ein unabhängiger Prädiktor des Therapieversagens der CBA.
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Acknowledgments
We thank Anne Gale of the Deutsches Herzzentrum Berlin for editorial assistance.
Compliance with ethical guidelines
Conflict of interest. J. Liu, J. Kaufmann, C. Kriatselis, E. Fleck, and J. Gerds-Li state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
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Liu, J., Kaufmann, J., Kriatselis, C. et al. Outcome of cryoballoon ablation for atrial fibrillation. Herz 40 (Suppl 2), 125–129 (2015). https://doi.org/10.1007/s00059-014-4152-8
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DOI: https://doi.org/10.1007/s00059-014-4152-8