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- Title
Outcomes of adjunct posterior wall isolation in atrial fibrillation patients with cardiac implantable electronic devices.
- Authors
Aryana, Arash; Thiemann, Anna M.; Pujara, Deep K.; Cossette, Laura L.; Allen, Shelley L.; Vierra, Eleanor C.; Bowers, Mark R.; Gandhavadi, Maheer; Heath, Russell; Trivedi, Amar D.; O'Neill, Padraig Gearoid; Ellis, Ethan R.; d'Avila, André
- Abstract
Background: Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI). Methods: This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF). Results: Acute PVI was achieved in all patients using cryoballoon ablation. Compared to PVI alone, PVI+PWI was associated with longer cryoablation, fluoroscopy, and total procedure times. Adjunct radiofrequency was required to complete PWI in 29/77 patients (37.7%). Adverse events were similar with PVI alone versus PVI+PWI. But at 24 ± 7 months of follow‐up, not only cryoballoon PVI+PWI was associated with improved freedom from recurrent AF (74.3% vs. 46.0%, P =.007) and all atrial tachyarrhythmias (71.4% vs. 38.1%, P =.001) in patients with PersAF, cryoballoon PVI+PWI also yielded greater freedom from AF (88.1% vs. 63.7%, P =.003) and all atrial tachyarrhythmias (83.3% vs. 60.8%, P =.008) in those with PAF. Additionally, PVI+PWI was associated with higher reductions in atrial tachyarrhythmia burden (97.9% vs. 91.6%, P <.001), need for cardioversion (5.2% vs. 23.6%, P <.001) and repeat catheter ablation (10.4% vs. 26.1%, P =.005), and a longer time‐to‐arrhythmia recurrence (16 ± 6 months vs. 8 ± 5 months, P <.001) in both PersAF and PAF patients. Conclusion: In CIED patients with PersAF or PAF, cryoballoon PVI+PWI is associated with a greater freedom from recurrent AF and atrial tachyarrhythmias, as compared to PVI alone during long‐term follow‐up.
- Subjects
ECHOCARDIOGRAPHY; RESEARCH; CARDIAC surgery; LOG-rank test; ATRIAL fibrillation; IMPLANTABLE cardioverter-defibrillators; CRYOSURGERY; RETROSPECTIVE studies; FISHER exact test; MANN Whitney U Test; TREATMENT effectiveness; T-test (Statistics); DESCRIPTIVE statistics; CHI-squared test; KAPLAN-Meier estimator; PULMONARY veins; DATA analysis software; COMPUTER-assisted image analysis (Medicine); ABLATION techniques; EQUIPMENT &; supplies; EVALUATION
- Publication
Pacing & Clinical Electrophysiology, 2023, Vol 46, Issue 7, p563
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.14767