Redalyc.Paroxysmal Atrial Fibrillation: Cryoballoon Versus
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Revista Argentina de Cardiología ISSN: 0034-7000 [email protected] Sociedad Argentina de Cardiología Argentina OROSCO, AGUSTÍN; VECCHIO, NICOLÁS; TOMAS, LEANDRO; ALBINA, GASTÓN; RIVERA, SANTIAGO; SCAZZUSO, FERNANDO Paroxysmal Atrial Fibrillation: Cryoballoon versus Radiofrequency Catheter Ablation Revista Argentina de Cardiología, vol. 85, núm. 2, abril, 2017, pp. 124-127 Sociedad Argentina de Cardiología Buenos Aires, Argentina Available in: http://www.redalyc.org/articulo.oa?id=305352117008 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative BRIEF REPORT Paroxysmal Atrial Fibrillation: Cryoballoon versus Radiofrequency Catheter Ablation Fibrilación auricular paroxística: crioablación versus ablación por radiofrecuencia AGUSTÍN OROSCO, NICOLÁS VECCHIO, LEANDRO TOMAS, GASTÓN ALBINAMTSAC, SANTIAGO RIVERAMTSAC, FERNANDO SCAZZUSO ABSTRACT Background: There are few data about which is the best technique for the treatment of paroxysmal atrial fibrillation: radiofrequency catheter ablation or cryoballoon ablation. Objective: The aim of this study was to compare immediate and long-term outcomes of irrigated radiofrequency ablation with second-generation cryoballoon ablation. Methods: This retrospective, observational, single-center study evaluated 159 consecutive patients with paroxysmal atrial fibrilla- tion undergoing pulmonary vein isolation using radiofrequency or cryoballoon ablation. Patient and procedure characteristics, the immediate success rate and the 12-month outcome were assessed. Results: Among a total of 159 patients, 89 underwent cryoballoon ablation and 70 radiofrequency ablation. Mean follow-up was 12 months. There were no significant differences in the population characteristics. The immediate success rate was 97.8% with cry- oballoon ablation versus 97.1% with radiofrequency ablation (p=0.8). Freedom from atrial fibrillation at 12 months after a single procedure was 77.5% with cryoballoon versus 71.4% with radiofrequency (p=0.33) ablation. Cryoballoon ablation was associated with shorter procedure duration compared with radiofrequency ablation (60.19±15 minutes vs. 75.8±31 minutes, respectively; p <0.00001), with shorter left atrial dwell time (45±14 minutes vs. 58±26 minutes; p <0.00001). Fluoroscopy time was significantly higher in the cryoballoon group (18±3.76 minutes vs. 13±2.23 minutes for radiofrequency; p <0.0001). The rate of complications was similar with both procedures (p=0.76). Conclusion: Compared with irrigated radiofrequency ablation, cryoballoon ablation was associated with shorter procedure time and similar rate of complications and freedom from atrial fibrillation at 12 months after a single procedure. Key words: Atrial Fibrillation - Cryoablation – Radiofrequency RESUMEN Introducción: En la ablación de la fibrilación auricular paroxística por radiofrecuencia o crioablación existe poca información acerca de la superioridad de una técnica sobre la otra. Objetivo: Comparar los resultados agudos y a largo plazo de las técnicas de ablación de la fibrilación auricular paroxística por catéter irrigado y mediante crioablación con balón de segunda generación. Material y métodos: Estudio retrospectivo, observacional, unicéntrico, en el que se evaluaron 159 pacientes consecutivos con fi- brilación auricular paroxística, a los cuales se les realizó aislamiento de venas pulmonares mediante radiofrecuencia o crioablación. Se examinaron las características de los pacientes y del procedimiento, así como el éxito inmediato y en el seguimiento a 12 meses. Resultados: Sobre un total de 159 pacientes, 89 procedimientos se realizaron con crioablación y 70 mediante radiofrecuencia. El seguimiento promedio fue de 12 meses. No se encontraron diferencias significativas en las características de la población. La tasa de éxito inmediato fue del 97,8% con crioablación versus 97,1% con radiofrecuencia (p = 0,8). La tasa libre de fibrilación auricular a los 12 meses luego de un único procedimiento fue del 77,5% mediante crioablación versus 71,4% con radiofrecuencia (p = 0,33). La cri- oablación con balón se asoció con menor duración del procedimiento respecto de la radiofrecuencia (60,19 ± 15 minutos frente a 75,8 ± 31 minutos, respectivamente; p < 0,00001), con menor tiempo en la aurícula izquierda (45 ± 14 minutos frente a 58 ± 26 minutos; p < 0,00001). Los tiempos de fluoroscopia fueron significativamente mayores para el grupo crioablación (18 ± 3,76 minutos vs. 13 ± 2,23 minutos para radiofrecuencia; p < 0,0001). La tasa de complicaciones crioablación vs. radiofrecuencia fue similar (p = 0,76). Conclusión: La crioablación con balón, en comparación con radiofrecuencia mediante catéter irrigado, se asoció con menor tiempo del procedimiento, similar tasa de complicaciones y tasa libre de fibrilación auricular a los 12 meses luego de un único procedimiento. Palabras clave: Fibrilación auricular - Crioablación - Radiofrecuencia Abbreviations CB Cryoballoon LMWH Low-molecular-weight heparin AF Atrial fibrillation RF Radiofrequency REV ARGENT CARDIOL 2017;85:124-127. http://dx.doi.org/10.7775/rac.v85.i2.9465 Received: 10/07/2016 – Accepted: 02/14/2017 Address for reprints: Dr. Agustín Orosco - Instituto Cardiovascular de Buenos Aires - Blanco Encalada 1543, Buenos Aires, Argentina - Tel. 4787-7500 extension 3855 - e - mail: [email protected] Instituto Cardiovascular de Buenos Aires, Department of Electrophysiology. Buenos Aires, Argentina. MTSAC Full Member of the Argentine Society of Cardiology PAROXYSMAL ATRIAL FIBRILLATION / Agustín Orosco et al. 125 INTRODUCTION venous infusion was started 6 hours after the procedure, According to a 2012 expert consensus, catheter abla- followed by oral anticoagulants for 3 months. All the an- tion of paroxysmal atrial fibrillation (AF) refractory to tiarrhythmic therapies were resumed after the procedure antiarrhythmic therapy is a Class I, level of evidence and continued for the same period. A recommendation. (1) Follow-up consisted of visits to the Atrial Fibrillation Clinic at 1, 2, 3, 6, 9 and 12 months after the procedure, and Point-by-point radiofrequency (RF) ablation is the included medical interview, physical examination, chest-X procedure most commonly used, leading to necrosis ray, 12-lead electrocardiography and 24-hour Holter moni- by tissue heating. As the method uses electroanatom- toring. ic mapping, a limited use of fluoroscopy is required. However, as the complexity of the technique involves Statistical analysis extensive training, it is restricted to specialized cent- Discrete variables are expressed as percentages and contin- ers, thus limiting the availability of AF ablation. (2, 3) uous variables as mean or median with their correspond- Although RF is the source of energy most widely ing standard deviation or interquartile range, according to used, cryoballoon (CB) ablation offers certain advan- their distribution. The chi square test was used to compare tages for the treatment of paroxysmal AF. These in- discrete variables and continuous variables were analyzed clude reduced pain and discomfort during and after using Student’s t test or the Mann-Whitney test according the procedure, improved catheter stability, dimin- to sampling distribution. A p value < 0.05 was considered statistically significant. The Kaplan-Meier method was ished risk of thrombosis due to decreased activation of used to evaluate freedom from AF. All the statistical calcu- platelets and the coagulation cascade and, finally, the lations were performed using SPSS 21.0 software package. ability to rapidly create circumferential and contigu- ous lesions. In addition, the relative simplicity and the Ethical considerations lower learning curve of the procedure, associated with The study protocol was approved by the institutional Eth- the potential for enhanced efficiency, have led to the ics Committee. An informed consent was not required be- widespread adoption of this technique. (3-6) cause the study was retrospective (Law 3101, CABA). The The aim of this study was to compare the immedi- Argentine personal data protection law 25,326 ensures the ate and long-term outcomes of paroxysmal AF abla- confidentiality of all the information. tion using irrigated RF or second-generation CB in our setting. RESULTS Among a total of 159 patients, 89 underwent CB abla- METHODS tion and 70 received RF ablation. Most patients were Study design, population and management before ablation men (79.8% in the CB ablation group and 67.1% in RF This retrospective, observational and single-center study, ablation group, p=0.07) and mean age was 56.7±11 conducted at the Instituto Cardiovascular de Buenos Aires years in the CB ablation and 61.2±10.5 years in the from August 2014 to August 2015, evaluated 159 consecu- RF ablation group (p=0.1). All the patients had a his- tive patients with paroxysmal AF refractory to antiarrhyth- tory of documented recurrent paroxysmal AF refrac- mic treatment undergoing pulmonary vein isolation using second-generation CB ablation (n=89) or irrigated RF abla- tory to antiarrhythmic treatment lasting between 2 tion (n=70). and 6 years. Average CHA2DS2-VASc score was 1 (1-3) Exclusion criteria were: persistent AF, secondary AF, con- in both groups. There were no significant differences gestive heart failure, severe valve stenosis or regurgitation, in