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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
35. Research Methodology
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Ablation Index-guided Ablation Versus Second-generation Cryoballoon Ablation For First Pulmonary Vein Isolation In Atrial Fibrillation: Short-term Results - A Single Center Experience
Session:
CO2 - Arritmias Supraventriculares
Speaker:
João Carmo
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Carmo; Francisco Moscoso Costa; Diogo Cavaco; Pedro Lopes Do Carmo; António Ferreira; Adriana Cavalcante; Gustavo Da Rocha Rodrigues; António Xavier Fontes; Afonso Félix De Oliveira; Daniel Nascimento Matos; Francisco Bello Morgado; Pedro Adragão; Miguel Mendes
Abstract
<p><strong>Background:</strong> In a recent trial, cryoballoon (CB) ablation was non-inferior to radiofrequency ablation regarding effectiveness in atrial fibrillation (AF). Ablation index (AI) provides a more accurate estimation of ablation quality using three variables: power delivered with time, contact force and catheter stability. The additional benefit of AI-guided ablation versus CB ablation is unknown.<br /> <strong>Objective:</strong> To compare AI-guided ablation and CB ablation for first pulmonary vein isolation (PVI) in patients with AF.<br /> <strong>Methods:</strong> We assessed 141 patients (62±12 years old, 76 men and 126 paroxysmal AF) with drug refractory symptomatic AF submitted to AI-guided PVI (Thermocool SmartTouch®) or second-generation CB catheter (Arctic Front Advance ®). Endpoint was AF/AT/AFL recurrence after a 3-month blanking period with a minimum follow-up of 6 months. Cox regression was used to assess the relationship between type of ablation and AF recurrence.<br /> <strong>Results:</strong> Fifty-seven patients underwent AI-guided PVI and 84 patients underwent CB ablation. The baseline characteristics are described in Fig A. Procedure duration was significantly higher in AI group (150 vs 111 min, P<0.001) although requiring significant less fluoroscopy time (5 min vs 20 min; P<0.001). There was a transient phrenic nerve palsy in CB group and a cardiac tamponade in AI group. During a mean follow-up of 10 ± 3 months there were 23 recurrences (27%) in CB group vs 7 recurrences (12%) in AI group (log rank 0.042) (Fig B). When adjusted for CHA<sub>2</sub>DS<sub>2</sub>-VASc score, left atrium diameter (mm) and type of AF (Cox regression), there was lower arrhythmia recurrence in AI group (HR 0.42; 95% CI 0.18-0.99; p=0.047).<br /> <strong>Conclusion:</strong> In this analysis, AI-guided ablation was associated with lower arrhythmia recurrence when compared with CB ablation. This hypothesis should be further evaluated in a prospective randomized trial.</p>
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