Key result
Left atrial appendage isolation plus pulmonary vein isolation using cryoballoon resulted in 67.9% of persistent atrial fibrillation patients maintaining sinus rhythm at a median 55 months.
Why the study?
Pulmonary vein isolation alone has modest outcomes in persistent AF, leading to interest in targeting non-pulmonary vein triggers.
Does left atrial appendage isolation in addition to pulmonary vein isolation using cryoballoon provide long-term efficacy and safety in patients with persistent atrial fibrillation?
Observational (n=193)
Yes
Does left atrial appendage isolation in addition to pulmonary vein isolation using cryoballoon provide long-term efficacy and safety in patients with persistent atrial fibrillation?
Left atrial appendage isolation combined with pulmonary vein isolation using cryoballoon shows acceptable long-term maintenance of sinus rhythm in persistent AF, though thromboembolic events remain a concern with anticoagulant non-adherence.
May support adjunctive cryoballoon LAA isolation in persistent AF; leaves open confirmation by randomized trials before practice change.
AIMS: There is an increasing trend evaluating the role of non-pulmonary vein (PV) triggers to improve ablation outcomes in persistent atrial fibrillation (AF) as pulmonary vein isolation (PVI) strategy alone has modest outcomes. We investigated the long-term safety and efficacy of left atrial appendage isolation (LAAi) in addition to PVI using cryoballoon (CB) in persistent AF. METHODS AND RESULTS: In this multicentre retrospective analysis, we included a total of 193 persistent AF patients (mean age: 60 ± 11 years, 50.3% females) who underwent PVI and LAAi using CB. Baseline and follow-up data including electrocardiography (ECG), 24 h Holter ECGs, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a median follow-up of 55 (36.5-60.0) months, 85 (67.9%) patients with PVI + LAAi were in sinus rhythm after the index procedure. Ischaemic stroke/transient ischemic attack occurred in 14 (7.2%) patients at a median of 24 (2-53) months following catheter ablation. Multivariate regression analysis revealed heart failure with preserved ejection fraction [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.04-5.02; P = 0.038], male gender (HR 0.53, 95% CI 0.29-0.96; P = 0.037), and LA area (HR 1.04, 95% CI 0.53-1.32; P = 0.023) as independent predictors of ATa recurrence. CONCLUSION: Our findings demonstrated that the LAAi + PVI strategy using CB had acceptable long-term outcomes in patients with persistent AF. Systemic thrombo-embolic events are an important concern throughout the follow-up, which were mostly observed in case of non-adherence to anticoagulants.
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Yorgun et al. (2022) conducted an observational in persistent atrial fibrillation (n=193). Left atrial appendage isolation (LAAi) in addition to pulmonary vein isolation (PVI) using cryoballoon was evaluated on Maintenance of sinus rhythm. Left atrial appendage isolation plus pulmonary vein isolation using cryoballoon resulted in 67.9% of persistent atrial fibrillation patients maintaining sinus rhythm at a median 55 months.
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