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Curso de Atualização em Medicina Cardiovascular 2019
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Contact-force Sensing Technology Versus Second-generation Cryoballoon For First Pulmonary Vein Isolation: A Propensity Score Analysis
Session:
CO10 - Arritmologia
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, pulmonary vein isolation (PVI) with cryoballoon (CB) was non-inferior to radiofrequency (RF) regarding recurrence of atrial fibrillation (AF). However, contact-force sensing (CF) technology was used in only 25% of patients in the RF group.<br /> <strong>Objective:</strong> To evaluate efficacy and safety of RF irrigated catheter with CF technology versus CB for first PVI.<br /> <strong>Methods:</strong> Single-center registry of 470 consecutive patients with drug-resistant AF who underwent first PVI between January 2014 and June 2018: 90 procedures with second-generation CB (Arctic Front Advance ®) and 380 with CF catheter (ThermoCool® SmartTouch®) . Endpoint was AF/AT/AFL recurrence after a 3-month blanking period. A propensity score (PS) model was developed using type of ablation as the dependent variable and relevant baseline characteristics as covariates. PS probabilities in the treatment group (CB) were matched in a 1:2 fashion (caliper 0.1) to the nearest control patient (CF).<br /> <strong>Results:</strong> PS matched 83 patients who underwent PVI using CB with 157 controls (CF), yielding well-balanced groups (Fig. A). During a mean follow-up of 15±8 months, recurrence was 34% (54 patients) in the CF group versus 33% (27 patients) in CB group (log rank 0.782) (Fig. B). CF ablation was associated with shorter fluoroscopy (9 vs 21 min; P<0.001) but longer procedure time (145 vs 108 min, P<0.001) when compared to CB ablation. Major complications were rare for both groups (1 transient phrenic nerve palsy for CB and 1 cardiac tamponade for CF).<br /> <strong>Conclusion:</strong> In this analysis, CF ablation had similar efficacy during short-term follow-up when compared to CB, although requiring significantly lower fluoroscopy time.<br /> </p>
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