Key result
Cryoballoon ablation for pulmonary vein isolation had a significantly higher 1-year incidence of iatrogenic atrial septal defect compared to radiofrequency ablation (22.2% vs 8.5%; P=0.03).
Why the study?
Does cryoballoon ablation increase the incidence of iatrogenic septal defect compared to conventional radiofrequency ablation in patients undergoing pulmonary vein isolation?
Cohort (n=127)
No
Does cryoballoon ablation increase the incidence of iatrogenic septal defect compared to conventional radiofrequency ablation in patients undergoing pulmonary vein isolation?
Absolute Event Rate: 22.2% vs 8.5%
p-value: p=0.03
Cryoballoon ablation for pulmonary vein isolation is associated with a significantly higher incidence of iatrogenic atrial septal defect at 1 year compared to radiofrequency ablation, although no adverse clinical events were observed.
Cryoballoon PVI was associated with higher iatrogenic ASD incidence; leaves open clinical relevance and requires randomized confirmation.
BACKGROUND: Transseptal (TS) catheterization is needed to access the left heart during pulmonary vein isolation (PVI) procedures. In the radiofrequency (RF) ablation procedure, left atrial access is commonly achieved with a double TS puncture; cryoballoon (CB) ablation usually requires only a single TS puncture. Our aim was to compare the incidence of iatrogenic septal defect (IASD) between double transseptal conventional RF and CB ablation. METHODS AND RESULTS: Individuals having undergone PVI as index procedure by RF or CB ablation and a subsequent transesophageal echocardiography examination during postablation follow-up in our center were consecutively included. A total of 127 patients formed the study group (92 males; mean age 60 ± 11 years). IASD was present in 17 patients (13.4%) after a mean follow-up time of 11.6 months. The incidence of IASD at 1-year follow-up following PVI was significantly higher in the CB ablation group compared with the RF ablation group (22.2% vs 8.5%; P = 0.03). Mean IASD diameter was larger in the CB group (0.60 cm × 0.50 cm vs 0.44 cm × 0.35 cm) without statistical significance. Only left to right atrial shunt was observed. No adverse events were recorded in these patients during the follow-up. CONCLUSIONS: the incidence of IASD at 1-year follow-up following CB ablation procedure for PVI is significantly higher with respect to RF procedures. Although no adverse clinical events were recorded in patients with persistence of IASD, more detailed echocardiographic examinations might be advised in all individuals exhibiting this finding.
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Mugnai et al. (2015) conducted a cohort in Pulmonary vein isolation (PVI) (n=127). Cryoballoon (CB) ablation vs. Conventional radiofrequency (RF) ablation was evaluated on Incidence of iatrogenic septal defect (IASD) at 1-year follow-up (p=0.03). Cryoballoon ablation for pulmonary vein isolation had a significantly higher 1-year incidence of iatrogenic atrial septal defect compared to radiofrequency ablation (22.2% vs 8.5%; P=0.03).
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