SPC365

No need for cold feet – efficacy of cryoablation versus other ablation techniques

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: Nelson P. Cunha

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Posters
FP Number: ---
Authors: Nelson P. Cunha; Tiago Rodrigues; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Beatriz Valente Silva; Catarina Oliveira; João Ribeiro; Afonso Nunes-Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction: </span></strong><span style="color:black">Atrial fibrillation (AF) is increasing in prevalence, alongside 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-to-point (PtP) ablation with irrigated catheter and 3D electroanatomic mapping. However, data on the efficacy and safety profiles of cryoablation is still lacking.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Purpose: </span></strong><span style="color:black">To evaluate the efficacy and safety profile of cryoablation and compare it with other AF ablation techniques, namely PVAC and PtP.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods: </span></strong><span style="color:black">Single centre study of AF patients (pts) refractory to antiarrhythmic therapy who performed 1<sup>st</sup> AF ablation procedure. The ablation strategy consisted of PVI, either by cryoablation, PbP or PVAC, complemented with ablation of the cavo-tricuspid isthmus in patients with history of concomitant flutter. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was assessed from the 90th day after ablation, with the absence of recurrences of any sustained atrial arrhythmias (&gt; 30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">We compared 319 pts submitted to PtP ablation (35.4% female, 58.03 &plusmn; 9 years old, 34.2% paroxysmal AF), 310 patients who underwent PVAC ablation (30.0% female, 58.83 &plusmn; 8 years old, 35.3% paroxysmal AF) and 232 pts submitted to cryoablation (31.9% female, 58.57&plusmn; 11 years old, paroxysmal AF).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">In the PVAC group there was a higher prevalence of structural cardiopathy (p= 0.013), dyslipidaemia (p=0.021) whereas hypertension was more prevalent in the cryoablation group (p=0.013). There were no other significant differences among these groups.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">There were no differences in the rate of supraventricular tachycardia (SVT) relapse at 3&ordm; year, when comparing the three different techniques (p=0.313).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">However we found significant differences (p=0.018) when analysing the rate of post-procedure complications in each technique: 4.1% (n=12) on the PVAC group, 9.9% on PtP group (n=30) and 5.9% (n=12) on the cryoablation group. Cardiac tamponade was the most frequent complication following PtP procedure (3.4%, n=11) in comparison to only one event in cryoablation (0.4%, n=1).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">With regard to the types of AF, we noted better results with cryoablation in the paroxysmal AF group (p=0.039)</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusions: </span></strong><span style="color:black">Cryoablation has demonstrated to be a safe and effective procedure, with similar relapse rates at 3 years as the other techniques. Cryoablation can represent an added value in AF ablation with a better safety profile when comparing to the classical PtP ablation technique.</span></span></span></p>