Why the study?
Although PVI remains the cornerstone of AF catheter ablation, several studies have illustrated clinical benefits associated with adjunct posterior wall isolation.
Does adjunct posterior wall isolation (PWI) added to pulmonary vein isolation (PVI) improve freedom from recurrent atrial fibrillation in patients with cardiac implantable electronic devices?
Cohort
Does adjunct posterior wall isolation (PWI) added to pulmonary vein isolation (PVI) improve freedom from recurrent atrial fibrillation in patients with cardiac implantable electronic devices?
In patients with CIEDs and AF, adding posterior wall isolation to cryoballoon pulmonary vein isolation significantly reduces long-term arrhythmia recurrence and burden compared to PVI alone.
May support adjunct PWI in CIED patients with AF; leaves open need for RCT confirmation.
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.
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Aryana et al. (2023) conducted a cohort in Paroxysmal or persistent atrial fibrillation in patients with cardiac implantable electronic devices. Pulmonary vein isolation with posterior wall isolation (PVI+PWI) vs. Pulmonary vein isolation (PVI) alone was evaluated on Freedom from recurrent AF in patients with persistent AF (p=0.007).
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