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Cryoablation: procedural outcomes for a successful pulmonary vein isolation
Session:
Posters (Sessão 1 - Écran 1) - Ablação Fibrilhação Auricular
Speaker:
Ana Rita Teixeira
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Rita Teixeira; Pedro Silva Cunha; Ana Lousinha; Guilherme Portugal; Bruno Valente; Madalena Coutinho Cruz; Ana Sofia Delgado; Manuel Brás; Margarida Paulo; Inês Maia; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Backgroud:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> A significant percentage of patients (pts) with recurrent atrial fibrillation (AF) undergo radiofrequency (RF) ablation after cryoballoon ablation (CBA). However, there is some lack in the literature about the pulmonary vein (PV) reconnection and procedural predictors of recurrence. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> To evaluate the efficacy of CBA and determine the clinical and procedural predictors of AF recurrence. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Single-centre retrospective study that included all pts with AF who underwent CBA between 2009 and 2020. <span style="background-color:white">AF recurrence was defined as any recurrence of AF, atrial flutter, or atrial tachycardia >30 seconds (recorded in 12-lead electrocardiogram or Holter) after 90 days of CBA. Demographic, clinical and procedure related data was retrieved. </span></span></span></span> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> We included 193 pts, 118 male (61%), mean age 57<span style="background-color:white">±13</span> years. Paroxysmal AF was found in 154 (79.8%) pts. Most </span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">were treated with some antiarrhythmic drug (65.8%)</span></span></span><span style="font-family:"Calibri",sans-serif"><span style="color:black">. </span>The mean cryoablation time (MCT) was lowest for the right superior PV (RSPV): 313.98±162.01s, p=0.002. The nadir balloon temperature (NBT) was lower for the superior (left: -48.47±9.88ºC, right: -49.23±8.36ºC) compared with inferior PVs (left: -46.24±7.54ºC, right: -46.67±7.82ºC; <em>p</em>=0.002). Procedural complications occurred in 16 (8.3%) pts. <span style="background-color:white"><span style="color:black">The success rate at one year was 85.5%. </span></span><span style="color:black">AF recurrence was present in 58 pts (30%), 16<span style="background-color:white">±15</span> months after CBA. </span><span style="color:black">There was a statistically significant association between AF type (namely, persistent) and recurrences (</span><em><span style="color:#222222">p</span></em><span style="color:black">=0.021). </span><span style="background-color:white"><span style="color:#212529">The MCT between right and left PVs (RPVs and LPVs, respectively) was significantly different in all pts (p=0.010), however it was not when comparing recurrences and non-recurrences (LPVs:</span></span>374.81±181.02s vs 364.48±196.49s, p=0.45, RPVs: 330.21±168.59s vs 335.04±185.46s, p=1.00). <span style="background-color:white"><span style="color:#212529">NBT was more negative in non-recurrences compared to recurrences, with no statistical difference (LPVs:-</span></span>47.70±9.50ºC<span style="background-color:white"><span style="color:#212529"> vs </span></span>-46.58±7.02ºC, p=0.87, RPVs: -48.11±8.52ºC<span style="background-color:white"><span style="color:#212529"> and -47.15</span></span>±8.70ºC, p=1.47).<span style="color:#222222"> No association was found between LA anatomy (4-PVs vs variants) and recurrences (<em>p</em>=0.09). </span><span style="color:black">Twenty-seven pts underwent a second ablation procedure, using RF. Among these, there were reconnection of 10 (37%) LSPVs, 10 (37%) LIPVs, 16 (59.3%) RSPVs and 15 (55.6%) RIPVs. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> <span style="color:black">Cryoballoon ablation </span><span style="background-color:white"><span style="color:#333333">is a safe and successful procedure. Despite the </span></span>higher incidence of conduction gaps in the right PVs, freezing time and nadir temperature was not significantly different between all PVs.</span></span></span></span></p>
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