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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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The long story of fire and ice: who is the winner?
Session:
Sessão de Comunicações Orais - Arritmias
Speaker:
Afonso Nunes Ferreira
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Nunes Ferreira; Nuno Cortez Dias; Pedro Silvério António; Inês Aguiar Ricardo; Tiago Graça Rodrigues; Joana Rigueira; Rafael Santos; Nelson P. Cunha; Sara Couto Pereira; Pedro Morais; Joana Quaresma; Luis Alves Carpinteiro; Fausto José Pinto; João Rodrigues De Sousa
Abstract
<p>Introduction:<br /> Atrial fibrillation (AF) is increasing in prevalence, along with the number of AF ablation procedures. Recently, one-shot techniques for AF ablation, such as cryoablation, have proved to perform pulmonary vein isolation (PVI) faster than the traditional point-by-point (PbP) ablation with irrigated catheter and 3D electroanatomic mapping. However, data on the efficacy and safety profiles of cryoablation are lacking.</p> <p>Purpose:<br /> To evaluate the efficacy and safety profiles of cryoablation and compare it to the conventional AF ablation technique (PbP with irrigated catheter).</p> <p>Methods:<br /> Single-center study of AF patients refractory to antiarrhythmic therapy who performed 1st AF ablation procedure. The ablation strategy consisted of PVI with cryoablation or PbP with irrigated catheter, complemented with ablation of the cavo-tricuspid isthmus in patients with history of concomitant flutter. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by AF-free survival or any maintained supraventricular tachycardia (duration > 30seconds).<br /> Propensity score matching was performed according to age and AF type (paroxysmal, short or long-term persistent).</p> <p>Results:<br /> 422 procedures were performed, with evaluation of 249 propensity matched procedures: 125 PbP vs 124 cryoablation (30.1% female, 58.1 ± 12.2 years old, follow-up duration 28.5 ± 28.2 months). Baseline clinical and therapeutic characteristics were similar between groups. From these patients, 74.4% had paroxysmal AF, 12% short-standing and 13.6% long-standing persistent AF.<br /> Among patients treated with cryoablation, 99% of the pulmonary veins were acutely isolated (499/504), similar to the 97.8% immediate success of PbP ablation (502/514), p=NS. Although the complication rate was similar between cryoablation and PbP (6.5% vs 6.4%, p=NS), the risk of hemopericardium was lower with cryoablation (0% vs 4%, p=0.024). The duration of the procedure and the fluoroscopy time were both reduced with the cryoablation vs PbP [95.0 (75-120) min vs 210 (190-259) min, p<0.01; 14.0 (10-19.7) min vs 27.0 (15.5-40.0) min, respectively]. The 1-year success rate after 1st ablation was 94.3% for cryoablation and 82.3% for PbP, with no difference between groups. A lower number of patients with cryoablation suspended antiarrhythmic therapy at 12 months (6% vs 19%, p<0.01).</p> <p>Conclusion:<br /> In 1st AF ablation procedures, cryoablation has demonstrated to be a safe and effective procedure, with similar acute and 12-month success rates to conventional point-by-point ablation. Cryoablation can represent an added value in AF ablation, making the procedure simpler, faster and with a lower risk of cardiac tamponade.</p>
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