The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=650). Intervention: Ablation technologies (iRF, PVAC, cryoballoon) vs. Compared to each other. Primary outcome: Incidence of Left Atrial Tachycardias (LAT).

Q: What does this research mean for the field?

The incidence of left atrial tachycardias following pulmonary vein isolation is lowest when using a phased multi-electrode radiofrequency catheter (0.7%) compared to irrigated radiofrequency (3.7%) and cryoballoon (4.0%) ablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Patrick Leitz; Kristina Wasmer; Christian Andresen; Fatih Güner; Julia Köbe; Benjamin Rath; Florian Reinke; Julian Wolfes; Philipp S. Lange; Christian Ellermann; Gerrit Frommeyer; Lars Eckardt

doi:10.3390/jcdd9020050

February 3, 2022Journal of Cardiovascular Development and DiseaseOpen Access

The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies

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Key result

Post-PVI left atrial tachycardia occurs in ~3% of patients, lowest with PVAC ablation.

n=650

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Why the study?

Few data are available on whether the catheter used for pulmonary vein isolation influences the incidence and characteristics of post-ablation left atrial tachycardias.

Does the ablation technology used for pulmonary vein isolation influence the incidence and characteristics of post-PVI left atrial tachycardias in patients with atrial fibrillation?

Key Points

To evaluate the incidence, electrophysiological mechanisms, and ablation outcomes of left atrial tachycardias (LAT) following pulmonary vein isolation (PVI) performed with three distinct catheter technologies.
Analyzed 650 patients with paroxysmal (n = 401) or persistent atrial fibrillation undergoing initial PVI between 2011 and 2020 using a prospectively designed single-center database.
Compared three ablation modalities: single-tip irrigated radiofrequency (iRF; n = 300), phased multi-electrode radiofrequency (PVAC; n = 150), and second-generation cryoballoon (n = 200).
Monitored patients through 3-month in-person visits and routine telephone interviews at 6, 12, and 6- to 12-month intervals, followed by 3D activation and voltage mapping for documented LAT.
LAT occurred in 3.7% of the iRF group (mean follow-up 22 ± 14 months), 0.7% of the PVAC group (mean follow-up 21 ± 14 months), and 4% of the cryoballoon group (mean follow-up 15 ± 8 months).
Baseline characteristics were comparable across cohorts, though the cryoballoon group had a higher proportion of persistent atrial fibrillation (p = 0.05); no independent predictors of LAT were identified.
Macro-reentrant tachycardia was the predominant arrhythmia mechanism, with reconnection of at least one pulmonary vein detected in 87% of patients mapped in 3D.

Study Design

Type

Cohort (n=650)

Multicenter

No

Structured PICO

Does the ablation technology used for pulmonary vein isolation influence the incidence and characteristics of post-PVI left atrial tachycardias in patients with atrial fibrillation?

P

Population

650 patients with paroxysmal or persistent atrial fibrillation undergoing their first pulmonary vein isolation, followed for a mean of 19 months.

E

Exposure

Pulmonary vein isolation using phased multi-electrode radiofrequency catheter (PVAC) (n=150) or cryoballoon ablation (n=200).

C

Comparator

Pulmonary vein isolation using irrigated single-tip radiofrequency catheter (iRF) (n=300).

O

Outcome

Occurrence of left atrial tachycardias (LAT) post PVI.hard clinical

The occurrence of left atrial tachycardia after pulmonary vein isolation is rare (approximately 3%) and appears independent of the catheter technology used, with macro-reentry and pulmonary vein reconnection being the predominant mechanisms.

Limitations

Non-randomized study with catheter choice at operator's discretion
Non-continuous follow-up may have missed asymptomatic LATs
Use of newer RF ablation technologies may have affected LAT rates in the iRF group
Non-randomized study; choice of ablation catheter was made at the operator's discretion
Non-continuous follow-up may have missed some asymptomatic LATs
Use of newer developments in point-by-point RF ablation may have affected the LAT occurrence rate in the iRF group

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Implication

Post-PVI LAT rates appear lowest with PVAC; observational data leave open any causal effect of ablation technology.

Abstract

Background: Left atrial tachycardias (LAT) are a well-known outcome of pulmonary vein isolation (PVI). Few data are available on whether the catheter used to perform PVI influences the incidence, as well as the characteristics of post PVI LAT. We present data on LAT following PVI by the following three ablation technologies: (1) phased multi-electrode radiofrequency catheter (PVAC), (2) irrigated single-tip catheter (iRF), and (3) cryoballoon ablation. Methods: Using a prospectively designed single-center database, we analyzed 650 patients (300 iRF, 150 PVAC, and 200 cryoballoon) with paroxysmal (n = 401) and persistent atrial fibrillation (AF), who underwent their first PVI at our center. Results: The three populations were comparable in their baseline characteristics; however, the cryoballoon group comprised a higher percentage of patients with persistent AF (p = 0.05). The LAT rates were 3.7% in the iRF group (mean follow-up 22 ± 14 months), 0.7% in the PVAC group (mean follow-up 21 ± 14 months), and 4% in the cryoballoon group (mean follow-up 15 ± 8 months). The predominant mechanism of LAT was macro-reentrant tachycardia. Reconnection of at least one pulmonary vein was observed in 87% of the patients who underwent 3D mapping. No predictors for LAT occurrence were identified. Conclusion: The occurrence of LAT post PVI is rare; the predominant mechanism was macro-reentrant tachycardia. Reconnection of at least one pulmonary vein was observed in nearly all the LAT patients. In our retrospective analysis, the lowest rate of LAT was observed with the PVAC. No predictors for LAT occurrence were identified.

Discussion

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Cite This Study

Leitz et al. (2022) conducted a cohort in Atrial fibrillation (n=650). Ablation technologies (iRF, PVAC, cryoballoon) vs. Compared to each other was evaluated on Incidence of Left Atrial Tachycardias (LAT). The incidence of left atrial tachycardias after pulmonary vein isolation was 3% overall, with rates of 3.7% for irrigated radiofrequency, 0.7% for PVAC, and 4.0% for cryoballoon ablation.

synapsesocial.com/papers/6a18eff50048a5c8b24b0c8c https://doi.org/10.3390/jcdd9020050

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The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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