Why the study?
The study sought to assess the impact of intraprocedural heart rhythm (SR vs AF) on acute procedural characteristics, PVI durability, and long-term clinical outcomes of cryoballoon ablation.
Does performing cryoballoon ablation during atrial fibrillation improve procedural characteristics and durability of pulmonary vein isolation compared to sinus rhythm in patients with symptomatic atrial fibrillation?
Does performing cryoballoon ablation during atrial fibrillation improve procedural characteristics and durability of pulmonary vein isolation compared to sinus rhythm in patients with symptomatic atrial fibrillation?
Performing cryoballoon ablation during atrial fibrillation results in lower nadir balloon temperatures and a trend toward higher durability of pulmonary vein isolation compared to sinus rhythm, though long-term arrhythmia-free survival is similar.
AF during CB PVI linked to lower nadir temperatures with trend to durable isolation; leaves open whether rhythm affects clinical outcomes.
BACKGROUND: The current study sought to assess the impact of the intraprocedural heart rhythm (sinus rhythm [SR] vs. atrial fibrillation [AF]) on acute procedural characteristics, durability of pulmonary vein isolation (PVI) and long-term clinical outcomes of cryoballoon (CB) ablation. METHODS: A total of 195 patients with symptomatic paroxysmal (n = 136) or persistent AF (n = 59) underwent CB-based PVI. Ablation procedures were either performed in SR (SR group; n = 147) or during AF (AF group; n = 48). Persistent AF was more frequent in the AF group than in the SR group (62% vs. 20%). All other patient baseline characteristics did not differ between the two groups. RESULTS: The nadir temperature during the CB applications was significantly lower in the AF group than in patients in the SR group (-49 [interquartile range, -44; -54]°C vs. -47 [-42; -52]°C, p = 0.002). Median procedure and fluoroscopy times as well as the rate of real-time recordings were not different between the two groups. Repeat ablation for the treatment of atrial arrhythmia recurrence was performed in 60 patients (SR: 44 [30%] patients; AF: 16 [33%] patients), with a trend towards a lower rate of pulmonary vein reconnections in the AF group (p = 0.07). There was no difference in 3-year arrhythmia-free survival (p = 0.8). CONCLUSIONS: Cryoballoon-based PVI during AF results in lower nadir balloon temperatures and a trend towards a higher durability of PVI as compared to procedures performed in SR. The rate of real-time PVI recordings was not affected by the intraprocedural heart rhythm.
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Reißmann et al. (2020) studied this question.
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