Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-09-2019 | Magnetic Resonance Imaging

Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy: insights from the 1STOP project

Authors: A. Sagone, S. Iacopino, P. Pieragnoli, G. Arena, R. Verlato, G. Molon, G. Rovaris, A. Curnis, W. Rauhe, M. Lunati, G. Senatore, M. Landolina, G. Allocca, S. De Servi, C. Tondo

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

Abstract

Background

Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence.

Methods

Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging.

Results

Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390).

Conclusions

In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.

Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014;114(9):1453–68.CrossRefPubMed

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22:983–8.CrossRefPubMed

Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–25.CrossRefPubMed

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78.CrossRefPubMed

Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. HRS/EHRA/ECAS/ APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14:e275–444. https://doi.org/10.1016/j.hrthm.2017.05.012.CrossRefPubMedPubMedCentral

He X, Chen Y, Zhou Y, Huang Y, He J. One-year clinical outcome of pulmonary vein isolation using the second-generation Cryoballoon: a meta-analysis. Pacing Clin Electrophysiol. 2016;39(2):182–9.CrossRefPubMed

Arbelo E, Brugada J, Lundqvist CB, Laroche C, Kautzner J, Pokushalov E, et al. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J. 2017. https://doi.org/10.1093/eurheartj/ehw564.

Kuck K-H, Brugada J, Fürnkranz A, Metzne A, Ouyang F, Julian Chun KR, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45. https://doi.org/10.1056/NEJMoa1602014.CrossRefPubMed

Squara F, Zhao A, Marijon E, Latcu DG, Providencia R, Di Giovanni G, et al. Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicentre European evaluation. Europace. 2015;17(5):718–24.CrossRefPubMed

10.

Chen J, Yang ZG, Xu HY, Shi K, Long QH, Guo YK. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT. Eur Radiol. 2017;27(2):660–70. https://doi.org/10.1007/s00330-016-4411-6.CrossRefPubMed

11.

Liddy S, Buckley U, Kok HK, Loo B, Glover B, Dhillon GR, et al. Applications of cardiac computed tomography in electrophysiology intervention. Eur Heart J Cardiovasc Imaging. 2017;19:253–61. https://doi.org/10.1093/ehjci/jex312.CrossRef

12.

Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI /SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the north American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr. 2010;4(6):407.e1–33. https://doi.org/10.1016/j.jcct.2010.11.001.CrossRef

13.

Padeletti L, Curnis A, Tondo C, Lunati M, Porcellini S, Verlato R, et al. Pulmonary vein isolation with the cryoballoon technique: feasibility, procedural outcomes, and adoption in the real world: data from one shot technologies to pulmonary vein isolation (1STOP) project. Pacing Clin Electrophysiol. 2017;40(1):46–56.CrossRefPubMed

14.

Tondo C, Iacopino S, Pieragnoli P, Molon G, Verlato R, Curnis A, et al. ClinicalService 1STOP project investigators. Pulmonary vein isolation cryoablation for patients with persistent and long-standing persistent atrial fibrillation: clinical outcomes from the real-world multicenter observational project. Heart Rhythm. 2018;15(3):363–8.CrossRefPubMed

15.

Landolina M, Arena G, Iacopino S, Verlato R, Pieragnoli P, Curnis A, et al. Center experience does not influence long-term outcome and peri-procedural complications after cryoballoon ablation of paroxysmal atrial fibrillation: data on 860 patients from the real-world multicenter observational project. Int J Cardiol. 2018;272:130–6.CrossRefPubMed

16.

Yang E, Ipek EG, Balouch M, Mints Y, Chrispin J, Marine JE, et al. Factors impacting complication rates for catheter ablation of atrial fibrillation from 2003 to 2015. Europace. 2017;19(2):241–9.PubMed

17.

Mansur M, Holmvang G, Sosnovik D, Migrino R, Abbara S, Ruskin J, et al. Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:387–93.CrossRef

18.

Merchant FM, LevY MR, Iravanian S, Clermont EC, Kelli HM, Eisner RL, et al. Pulmonary vein anatomy assessed by cardiac magnetic resonance imaging in patients undergoing initial atrial fibrillation ablation: implications for novel ablation technologies. J Interv Card Electrophysiol. 2016;46:89–96.CrossRefPubMed

19.

De Maria E, Aldrovandi A, Borghi A, Modonesi L, Cappelli S. Cardiac magnetic resonance imaging: which information is useful for the arrhythmologist? World J Cardiol. 2017;9(10):773–86.CrossRefPubMedPubMedCentral

20.

Straube F, Dorwarth U, Schmidt M, Wankerl M, Ebersberger U, Hoffmann E. Comparison of the first and second cryoballoon: high-volume single-center safety and efficacy analysis. Circ Arrhythm Electrophysiol. 2014;7:293–9.CrossRefPubMed

21.

Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(1):32–8.CrossRefPubMed

22.

Andrade JG, Khairy P, Guerra PG, Deyell MW, Rivard L, Macle L, et al. Efficacy and safety of cryoballoon ablation for atrial fibrillation: systematic a systematic review of published studies. Heart Rhythm. 2011;8:1444–51.CrossRefPubMed

23.

Chao TF, Lin YJ, Tsao HM, Tsai CF, Lin WS, Chang SL, et al. CHADS2 and CHA2DS2-VASc scores in the prediction of clinical outcomes in patients with atrial fibrillation after catheter ablation. J Am Coll Cardiol. 2011;58(23):2380–5. https://doi.org/10.1016/j.jacc.2011.08.045.CrossRefPubMed

24.

Chao TF, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, et al. R2CHADS2 score and thromboembolic events after catheter ablation of atrial fibrillation in comparison with the CHA2DS2-VASc score. Can J Cardiol. 2014;30(4):405–12.CrossRefPubMed

25.

Letsas KP, Efremidis M, Giannopoulos G, Deftereos S, Lioni L, Korantzopoulos P, et al. CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation. Europace. 2014;16(2):202–7. https://doi.org/10.1093/europace/eut210.CrossRefPubMed

Title: Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy: insights from the 1STOP project
Authors: A. Sagone
S. Iacopino
P. Pieragnoli
G. Arena
R. Verlato
G. Molon
G. Rovaris
A. Curnis
W. Rauhe
M. Lunati
G. Senatore
M. Landolina
G. Allocca
S. De Servi
C. Tondo
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Computed Tomography
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/s10840-018-0500-6

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

At a glance: The STEP trials

Springer Medicine

Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy: insights from the 1STOP project

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

The use of a high-resolution mapping system may facilitate standard clinical practice in VE and VT ablation

Irreversible electroporation for catheter-based cardiac ablation: a systematic review of the preclinical experience

Demonstration of an adjacent conduction gaps-derived left atrial and pulmonary vein flutter by high-density mapping

Effect of early pendulum exercise on shoulder function after cardiac rhythm management device implantation

Heart failure progression and mortality in atrial fibrillation patients with preserved or reduced left ventricular ejection fraction

The role of microRNAs in the development, regulation, and treatment of atrial fibrillation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page