Key result
Cryoballoon ablation in patients with heart failure and CIEDs had similar procedure-related complications compared to controls without cardiac disease (6.7% vs 8.5%, p=0.76).
Why the study?
Is cryoballoon catheter ablation safe and effective for reducing atrial fibrillation burden and improving symptoms in patients with advanced systolic heart failure (LVEF ≤ 40%) and CIEDs?
Cohort (n=89)
Is cryoballoon catheter ablation safe and effective for reducing atrial fibrillation burden and improving symptoms in patients with advanced systolic heart failure (LVEF ≤ 40%) and CIEDs?
Cryoballoon ablation in patients with advanced systolic heart failure and CIEDs is safe and significantly reduces AF burden and symptoms at 6 months, despite a high rate of late arrhythmia recurrence.
May support short-term AF burden reduction in advanced HF with CIEDs; leaves open long-term efficacy and requires RCTs.
BACKGROUND: Pulmonary vein isolation with cryoballoon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF), but in patients with heart failure (HF) the role of CCB remains unknown. AIM: The aim of the study was to assess the feasibility, effectiveness, and safety of CCB in patients with HF and cardiac im-plantable electronic devices (CIEDs), the impact of the procedure on symptoms, and echocardiographic parameters. METHODS: Thirty consecutive HF patients with left ventricular ejection fraction (LVEF) ≤ 40% and CIED, referred for CCB of AF, were included. Procedural parameters were compared to a group of 59 consecutive patients without cardiac diseases referred for CCB (control group). RESULTS: The number of veins ablated per patient was smaller and application was performed less frequently in the right inferior pulmonary vein in the HF group compared with the control group (66.7% vs. 88.1%; p = 0.01, respectively). In two (6.7%) patients from the HF group and in five (8.5%) from the control group procedure-related complications occurred (p = 0.76). After six months 21 HF patients (70%), after one year 13 (43%), and after 625 days only three (10%) were free from arrhythmia. AF burden was significantly reduced after six months compared to the pre-ablation period (18.5% vs. 52.9%; p = 0.001). New York Heart Association and European Heart Rhythm Association classes were both significantly (p < 0.001) reduced and LVEF was higher after six months in the HF patients. CONCLUSIONS: Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally nor-mal heart; however, stable positioning of the balloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices.
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Pruszkowska et al. (2018) conducted a cohort in Atrial fibrillation in advanced systolic heart failure (n=89). Cryoballoon catheter ablation (CCB) vs. Patients without cardiac diseases referred for CCB was evaluated on Procedure-related complications (p=0.76). Cryoballoon ablation in patients with heart failure and CIEDs had similar procedure-related complications compared to controls without cardiac disease (6.7% vs 8.5%, p=0.76).
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