Pulmonary vein isolation using a cryoballoon significantly reduced mean atrial fibrillation burden from 24% at baseline to 5% at 3 months (p < 0.01).
Observational (n=57)
Does pulmonary vein isolation using a cryoballoon improve short-term outcomes and reduce AF burden in patients with paroxysmal atrial fibrillation?
Cryoballoon ablation for pulmonary vein isolation is feasible and significantly reduces AF burden in patients with paroxysmal AF, though phrenic nerve paralysis is a notable complication.
Absolute Event Rate: 5% vs 24%
p-value: p=< 0.01
AIMS: To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon. METHODS: We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the first three months were analysed, using a comprehensive and intensive follow-up period. RESULTS: During 57 procedures, 185 of 220 targeted PV's were successfully isolated using the cryoballoon (84%) (balloon group, 33 patients). In 33 veins (15%) an additional segmental isolation (hybrid group, 24 patients) was necessary with a standard cryocatheter to achieve isolation. The average procedure times were respectively 211 +/- 108 and 261 +/- 83 minutes (NS), the average fluoroscopy times 52 +/- 36 and 66 +/- 33 minutes (NS). The number of balloon applications did not differ between both groups: respectively a median 9 (4-18) and 10 (5-17) (NS). We observed four phrenic nerve paralysis after ablation of the right superior PV: two resolved immediately after cessation of the cryoenergy, one recovered after 3 months, one persisted up to 6 months. A daily transtelephonic rhythm recording showed a significant drop in mean AF burden from 24% to 10%, 8% and 5% during the three consecutive months of follow-up (p < 0.01 versus baseline). No differences were observed between the treatment groups. 34 patients (60%) were completely free from AF after a single procedure. CONCLUSIONS: Balloon cryoablation of the pulmonary veins with additional segmental isolation if necessary, is a good approach for patients presenting with paroxysmal AF, showing a significant reduction in AF burden after a single procedure. The major complication seems to be phrenic nerve paralysis after ablation of the right superior PV, but this is potentially reversible over several months.
Belle et al. (2007) conducted an observational in paroxysmal atrial fibrillation (n=57). Pulmonary vein isolation using a cryoballoon vs. Baseline was evaluated on mean AF burden (p=< 0.01). Pulmonary vein isolation using a cryoballoon significantly reduced mean atrial fibrillation burden from 24% at baseline to 5% at 3 months (p < 0.01).