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- Title
Acute and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second-Generation Cryoballoon versus Open-Irrigated Radiofrequency: A Multicenter Experience.
- Authors
ARYANA, ARASH; SINGH, SHELDON M.; KOWALSKI, MARCIN; PUJARA, DEEP K.; COHEN, ANDREW I.; SINGH, STEVE K.; ALEONG, RYAN G.; BANKER, RAJESH S.; FUENZALIDA, CHARLES E.; PRAGER, NELSON A.; BOWERS, MARK R.; D'AVILA, ANDRÉ; O'NEILL, PADRAIG GEAROID
- Abstract
Second-Generation Cryoballoon versus RF Introduction There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies. Methods and Results In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and open-irrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001). Conclusion In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone.
- Subjects
ATRIAL fibrillation; CATHETER ablation; CHI-squared test; CONFIDENCE intervals; CRYOSURGERY; FISHER exact test; MEDICAL cooperation; RESEARCH; RESEARCH funding; SURGICAL complications; T-test (Statistics); LOGISTIC regression analysis; PRODUCT design; TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; LOG-rank test; ODDS ratio; MANN Whitney U Test
- Publication
Journal of Cardiovascular Electrophysiology, 2015, Vol 26, Issue 8, p832
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.12695