In patients with persistent atrial fibrillation, a PVI-only strategy was a significant predictor of atrial tachyarrhythmia recurrence compared to PVI combined with left atrial appendage isolation (HR 3.01; 95% CI 1.81-5.03; P<0.001).
Cohort (n=282)
Does cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation reduce atrial tachyarrhythmia recurrence in patients with persistent atrial fibrillation?
Cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation significantly reduces long-term atrial tachyarrhythmia recurrence in patients with persistent atrial fibrillation compared to PVI alone.
Hazard Ratio: 3.01 (95% CI 1.81–5.03)
Tasa de eventos absoluta: 24.3% vs 38.4%
valor p: p=<0.001
AIMS: Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF. METHODS AND RESULTS: We compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG's, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81-5.03; P < 0.001). CONCLUSIONS: Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.
Yorgun et al. (Mon,) conducted a cohort in Persistent atrial fibrillation (n=282). Pulmonary vein isolation (PVI) combined with left atrial appendage isolation (LAAi) using cryoballoon vs. PVI-only was evaluated on Atrial tachyarrhythmia (ATa) recurrence (HR 3.01, 95% CI 1.81-5.03, p=<0.001). In patients with persistent atrial fibrillation, a PVI-only strategy was a significant predictor of atrial tachyarrhythmia recurrence compared to PVI combined with left atrial appendage isolation (HR 3.01; 95% CI 1.81-5.03; P<0.001).