The Impact of Left Atrial Surface Area and the Second Generation Cryoballoon on Clinical Outcome of Atrial Fibrillation Cryoablation

• Published in: Pacing and clinical electrophysiology Vol. 38; no. 7; pp. 815 - 824
• Main Authors: GREISS, HARALD, BERKOWITSCH, ALEXANDER, WOJCIK, MACIEJ, ZALTSBERG, SERGEJ, PAJITNEV, DIMITRI, DEUBNER, NIKOLAS, AKKAYA, ERSAN, GÜTTLER, NORBERT, HAMM, CHRISTIAN, NEUMANN, THOMAS, KUNISS, MALTE
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2015
• Subjects: ablation; Aged; arrhythmia; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; catheter ablation; Catheter Ablation - instrumentation; Catheter Ablation - methods; cryoballoon; Cryosurgery - instrumentation; Cryosurgery - methods; Echocardiography; Equipment Design; Equipment Failure Analysis; Female; Heart Atria - diagnostic imaging; Humans; long-term follow-up; Longitudinal Studies; Male; Middle Aged; paroxysmal atrial fibrillation; Prognosis; pulmonary vein isolation; Recurrence; Reproducibility of Results; Sensitivity and Specificity; tachyarrhythmias; Treatment Outcome; arrhythmia; long-term follow-up; ablation; cryoballoon; paroxysmal atrial fibrillation; catheter ablation; pulmonary vein isolation; tachyarrhythmias
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.12637

Aims In this observational study, we examine the significance of the left atrial (LA) surface area and compare the clinical usage of the Arctic Front Advance (CBA) versus Arctic Front (CB) cryoballoon with the intent to investigate the impact of each in terms of long‐term freedom from atrial fibrillation (AF) for patients with nonvalvular AF. Methods Pulmonary vein isolation (PVI) was performed while using a cryoballoon ablation catheter in conjunction with an intraluminal circular diagnostic mapping catheter, Achieve. The consecutive patients ablated with CBA were matched with patients previously ablated with CB, using propensity score matching. The primary endpoint of this observational single‐center retrospective study was the first observation of electrocardiogram‐documented recurrence of atrial arrhythmias lasting >30 seconds. Results The patient demographic data were similar in the CBA‐ and CB‐group (N = 188 patients each group). In all patients in the CBA‐group and in 95% of the patients in the CB group, acute procedural PVI of all veins was achieved with the single usage of a 28‐mm cryoballoon. The one‐year freedom from atrial arrhythmias was significantly better in the CBA‐ versus the CB‐group of patients, 90% versus 64%, respectively. During 15‐month clinical follow‐up in CBA group, patients with LA area above 23 cm2 were more likely to experience recurrence of AF (23%) than patients with LA area below 23 cm2 (7%). Conclusions Comparing one‐year outcomes, the CBA is superior to the CB with regards to maintenance of normal sinus rhythm. When using the CBA catheter, an enlarged LA is associated with a higher recurrence of arrhythmia.