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Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation
  1. Pipin Kojodjojo,
  2. Mark D O'Neill,
  3. Phang Boon Lim,
  4. Louisa Malcolm-Lawes,
  5. Zachary I Whinnett,
  6. Tushar V Salukhe,
  7. Nicholas W Linton,
  8. David Lefroy,
  9. Anthony Mason,
  10. Ian Wright,
  11. Nicholas S Peters,
  12. Prapa Kanagaratnam,
  13. D Wyn Davies
  1. Department of Cardiac Electrophysiology, St. Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
  1. Correspondence to Pipin Kojodjojo, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom; pipin.kojodjojo{at}imperial.ac.uk

Abstract

Background To prevent atrial fibrillation (AF) recurrence after catheter ablation, pulmonary venous isolation (PVI) at an antral level is more effective than segmental ostial ablation. Cryoablation around the pulmonary venous (PV) ostia for AF therapy is potentially safer compared to radiofrequency ablation (RFA). The aim of this study was to investigate the efficacy of a strategy using a large cryoablation balloon to perform antral cryoablation with ‘touch-up’ ostial cryoablation for PVI in patients with paroxysmal and persistent AF.

Methods Paroxysmal and persistent AF patients undergoing their first left atrial ablation were recruited. After cryoballoon therapy, each PV was assessed for isolation and if necessary, treated with focal ostial cryoablation until PVI was achieved. Follow-up with Holter monitoring was performed. Clinical outcomes of the cryoablation protocol were compared, with consecutive patients undergoing PVI by RFA.

Results 124 consecutive patients underwent cryoablation. 77% of paroxysmal and 48% of persistent AF subjects were free from AF at 12 months after a single procedure. Over the same time period, 53 consecutive paroxysmal AF subjects underwent PVI with RFA and at 12 months, 72% were free from AF at 12 months (p=NS). There were too few persistent AF subjects (n=8) undergoing solely PVI by RFA as a comparison group. Procedural and fluoroscopic times during cryoablation were significantly shorter than RFA.

Conclusions PV isolation can be achieved in less than 2 h by a simple cryoablation protocol with excellent results after a single intervention, particularly for paroxysmal AF.

  • Atrial fibrillation
  • cryoablation
  • radiofrequency ablation
  • pulmonary venous isolation
  • radiofrequency ablation (RFA)

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • Funding British Heart Foundation. Dr Pipin Kojodjojo is funded by a British Heart Foundation Travel Fellowship (FS/09/047).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of St. Mary's Hospital, Imperial College Healthcare NHS Trust.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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