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Curso de Atualização em Medicina Cardiovascular 2019
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Clinical outcome after cryoballon based pulmonary vein isolation for the treatment of paroxysmal and persistent atrial fibrillation: Large two-center experience
Session:
CO2 - Arritmias Supraventriculares
Speaker:
Pedro Silva Cunha
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:
Pedro Silva Cunha; Paulo Fonseca; Bruno Tereno Valente; Fernando Montenegro Sá; Guilherme Portugal; Helena Gonçalves; Mário Martins Oliveira; João Primo
Abstract
<p><strong>Background: </strong>Pulmonary vein isolation (PVI) using the cryoballoon (CB) in patients with paroxysmal (PAF) and as well as persistent atrial fibrillation (PersAF) has demonstrated encouraging acute and mid-term results. However, follow-up data on outcome beyond one year in Portugal is lacking.</p> <p><strong>Objective:</strong> The aim of this study is to characterize patients (P) submitted to CBA of AF in two Portuguese tertiary centers, and verify AF recurrence rates (between P with persistent and paroxysmal) and AF in a 12-month follow-up period after CBA.</p> <p><strong>Methods: </strong>246 patients with paroxysmal (207/246 [84,1%] patients) or persistent AF (39/246 [15,9%] patients) underwent CB-based PVI in two centers with large AF ablation experience. Freeze-cycle duration was 240 seconds. After successful PVI a bonus freeze-cycle of the same duration was applied in 223 patients while the bonus freeze was omitted in 23 patients. A total of 954 (99,1%) pulmonary veins were successfully isolated. Regarding anatomic variations of the venous ostia, we found that they were present in 13,8% (34/246) of the P (27 P had a left common ostia, 4 P had a right common ostia, 3 P had 3 right pulmonary vein separate ostia and 1 P had 3 left pulmonary veins separated ostia).</p> <p><strong>Results: </strong>The mean procedure time was 123,1 +/- 36,4 minutes. There were 15 (6,1%) transitory phrenic nerve palsys, that lead to stop acutely the application and repositioning the cryballoon, but in only 1 P the phrenic nerve palsy persisted at 6 months. After a mean follow-up duration of 23,1 months, 185 (75,2%) patients remained in stable sinus rhythm. 61 P had a recurrence, 42 (20,3%) P in paroxysmal AF group and 19 (48,7%) P in the persistent AF group. Out of the 61 P with recurrence, 27 P received a second procedure (in all P with radiofrequency ablation).</p> <p><strong>Conclusion: </strong>CB-based PVI in two Portuguese tertiary centers results in a 75,2% single-procedure success rate. The CB ablation procedure in experienced centers is globally safe and effective.</p>
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