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CRYO-3D - A three-dimensional mapping-guided cryoballoon-based atrial fibrillation ablation: feasibility and preliminary results
Session:
Comunicações Orais (Sessão 13) - Arritmias 3 - Fibrilhação auricular
Speaker:
André Paulo Ferreira
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
---
Session Type:
Comunicações Orais
FP Number:
---
Authors:
André Paulo Ferreira; Pedro Silva Cunha; Bruno Tereno Valente; Guilherme Portugal; Sérgio Laranjo; Ana Lousinha; Ana s Delgado; Margarida Paulo; Manuel Brás; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Background: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Cryoballoon-based ablation (CBA) has become widely used as a “single-shot” approach in the treatment of paroxysmal atrial fibrillation (AF) and persistent AF, being an unquestionable alternative approach to point-by-point radiofrequency (RF) ablation for circumferential pulmonary veins isolation (PVI). The CBA as the drawback of longer fluoroscopy times when compared with the RF.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Purpose: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">To demonstrate the potential benefits of a CBA procedural technique, utilizing the Achieve Advance Mapping Catheter and the Ensite Precision system to reduce the fluoroscopy times, maintaining procedure duration, safety and efficacy.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Consecutive patients submitted to AF ablation, with CBA and a 3D mapping system (Crio 3D group) between March 2021 and October 2021, were compared with a historical cohort of CBA (ConV group) from the previous 2 years. The circular mapping catheter was used to create electroanatomic maps with an open mapping system (EnSite Precision (Abbott, Inc.)) in all patients in the Crio 3D group.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Results: </span></span></strong><span style="font-size:11.0pt">A total of 37 CBA of AF using a </span><span style="font-size:11.0pt"><span style="color:black">3D mapping system </span></span><span style="font-size:11.0pt">were performed during the study period and included in the Crio 3D group. Patient mean age was 61.1</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">10.9 years, 51.4% were male (n=19) and paroxysmal AF was present in 70.3% (n=26) of cases. A total of 160 conventional CBA of AF were performed during the cohort period and included in the ConV group. There were no significant differences between group’s demographics. Mean left atrium (LA) size was similar between groups (35.6</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">9.7 ml/mm</span><span style="font-size:11.0pt">²</span><span style="font-size:11.0pt"> in the Crio 3D group vs 38.0</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">13.9 ml/mm</span><span style="font-size:11.0pt">² in the ConV group</span><span style="font-size:11.0pt">, p=0.592) and mean number of isolated pulmonary veins on each procedure was also similar (3.8</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">0.7 in the Crio 3D group vs 3.9</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">0.7 </span><span style="font-size:11.0pt">in the ConV group</span><span style="font-size:11.0pt">, p=0.609). In the Crio 3D group procedure time was significantly lower (79.2</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">20.9 vs 122.7</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">38.4 minutes, p<0.01) and so was fluoroscopy time (8.7</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">4.0 vs 21.1</span><span style="font-size:11.0pt">±</span><span style="font-size:11.0pt">9.2 minutes, p<0.01), when compared to the ConV group. Only one 1 (2.7%) acute complication was observed in the Crio 3D group, compared to </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">4 (2.5%) </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt">acute complications in the Conv group.</span></span></span></p> <p style="text-align:justify"> </p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">CBA with the aid of a 3D mapping system is feasible in a subset of patients referred to AF ablation and leads to a significant sustained decrease in both procedure and fluoroscopy times, when compared with the conventional approach.</span></span></span></p>
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