Left atrial linear cryoablation achieved a higher rate of sinus rhythm off antiarrhythmic drugs at 2 years compared to pulmonary vein cryoisolation alone (57% vs 20%) in patients with permanent AF.
RCT (n=105)
Does left atrial linear cryoablation improve the persistence of sinus rhythm compared to pulmonary vein cryoisolation alone in patients with permanent atrial fibrillation and valvular heart disease undergoing valve surgery?
In patients with permanent atrial fibrillation and valvular heart disease undergoing valve surgery, left atrial linear cryoablation is more effective than pulmonary vein isolation alone for maintaining sinus rhythm.
Absolute Event Rate: 57% vs 20%
BACKGROUND: The aim of this study was to clarify the role of pulmonary vein isolation (PVI) alone versus left atrial linear lesions in the treatment of permanent atrial fibrillation (AF) in patients with left atrial dilatation and valvular disease. The primary end point was to assess the persistence of sinus rhythm (SR) off antiarrhythmic drugs (AADs) at 2-year follow-up and to correlate clinical outcome with surgical results validated with electroanatomic mapping (EAM). METHODS AND RESULTS: A total of 105 patients with permanent AF undergoing valve surgery were assigned to 3 different groups: in groups "U" and "7," left atrial linear cryoablation was performed, whereas in group "PV" patients, anatomic cryoisolation of pulmonary veins only was performed. In groups U and 7, SR was achieved in 57% of patients, whereas it was achieved in 20% of PV patients during 2-year follow-up. In the first 51 patients, the ablation schemes were validated with EAM. The EAM showed that the U lesion was never obtained: in 59% of these patients, a complete 7 lesion was achieved instead; in the 7 group, a complete 7 lesion was present in 65% of patients, whereas a complete PVI was obtained in 71% of patients. Considering patients in whom a complete 7 lesion was demonstrated with the EAM, SR without AADs was achieved in 86% of patients, whereas only 25% of patients with complete PVI were in SR without AADs. CONCLUSIONS: In patients with permanent AF, left atrial dilatation and valvular heart disease linear lesions in the posterior region of the left atrium are more effective than PVI alone. With cryoablation, the surgical intent is fulfilled in only approximately 65% of the cases. Knowing the real anatomic and electrophysiological effects of surgical ablation is necessary to correctly interpret the clinical outcome.
Gaïta et al. (Wed,) conducted a rct in Permanent atrial fibrillation and valvular heart disease (n=105). Left atrial linear cryoablation vs. Pulmonary vein cryoisolation alone was evaluated on Persistence of sinus rhythm (SR) off antiarrhythmic drugs (AADs) at 2-year follow-up. Left atrial linear cryoablation achieved a higher rate of sinus rhythm off antiarrhythmic drugs at 2 years compared to pulmonary vein cryoisolation alone (57% vs 20%) in patients with permanent AF.
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