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Journal of Interventional Cardiac Electrophysiology

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01-12-2019 | Atrial Fibrillation

Touch-up and recurrence rates after voltage mapping for verification of pulmonary vein isolation following cryoablation of paroxysmal atrial fibrillation

Authors: Rajesh Malik, Bobby Malik, Tina D. Hunter

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2019

Abstract

Purpose

The procedural endpoint following cryoballoon ablation (CA) for paroxysmal atrial fibrillation (PAF) is pulmonary vein isolation (PVI), which is typically confirmed by entrance/exit block using a circular mapping catheter. The present study added an assessment of ablation gaps with high-density voltage mapping after standard confirmation of PVI. Relationships between the need for touch-up ablation, patient characteristics, and atrial arrhythmia recurrence were explored.

Methods

PAF patients received CA through standard of care treatment, with PVI assessed by bidirectional block confirmation, followed by voltage mapping. Radiofrequency ablation was performed as needed for voltage breakthrough and or additional rhythms. Freedom from atrial arrhythmia recurrence through 12-month follow-up was analyzed retrospectively with statistical survival models.

Results

A total of 77 PAF patients (age 66.1 ± 11.6, CHADS₂ 1.8 ± 1.0) were followed for 1.2 ± 0.3 years after CA. During the index procedure, pulmonary vein (PV) touch-up was required in 59 patients (76.6%) and ablation of additional atrial fibrillation targets beyond PV was required in 26 patients (33.8%). Kaplan-Meier estimates of freedom from atrial arrhythmia recurrence at 1 year were 62 ± 6%. Rates were lower for patients requiring touch-up ablation (58 ± 6% vs. 78 ± 10%) or with CHADS₂ scores > 2 (33 ± 12% vs. 69 ± 6%). Cox regression models showed that the need for touch-up ablation increased recurrence (p = .045, HR = 2.6) after adjusting for hypertension and heart failure.

Conclusion

The high rate of PV touch-up suggests that initial CA lesions may be less durable than previously assumed, while the higher recurrence rate in patients requiring touch-up may indicate that additional factors make these patients more difficult to treat.

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Title: Touch-up and recurrence rates after voltage mapping for verification of pulmonary vein isolation following cryoablation of paroxysmal atrial fibrillation
Authors: Rajesh Malik
Bobby Malik
Tina D. Hunter
Publication date: 01-12-2019
Publisher: Springer US
Keyword: Atrial Fibrillation
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2019
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-019-00533-y

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Touch-up and recurrence rates after voltage mapping for verification of pulmonary vein isolation following cryoablation of paroxysmal atrial fibrillation

Abstract

Purpose

Methods

Results

Conclusion

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