Long-term outcome of cryoballoon ablation versus radiofrequency ablation for focal atrial tachycardias originating from the pulmonary veins

Cryoballoon Ablation for Treatment of Atrial Fibrillation in a Chinese Population: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure

Background

The 5-year outcomes and predictors of atrial fibrillation (AF) recurrence following cryoballoon (CB) ablation in Chinese population remain scarce. Our aim was to report 5-year outcomes and predictors of AF recurrence following a single CB ablation procedure in a Chinese population.

Methods

From December 2013 to August 2016, we included 256 consecutive patients (mean age: 58 ± 10.9 years old; female: 41.0%) with paroxysmal or persistent AF successfully underwent first-generation CB ablation at Fuwai hospital in this prospective study. All patients were followed at least 5 years or when there was recurrent AF. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.

Results

The 5-year success rate after pulmonary vein isolation (PVI) by a single procedure was 59.4%. The recurrence rate was the highest (14.5%) within the first year after the index procedure, and then stabilized. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than patients with persistent AF (63.2% vs. 36.4%, log-rank P < 0.01). The overall incidence of complications related to CB ablation was 7.8%. Phrenic nerve injury (PNI) was the most common complication, with an incidence of 3.5%, and patients with PNI were recovered within the 1-year follow-up. Only persistent AF (HR 1.72, 95%CI 1.028–2.854, P < 0.05) was significantly and independently associated with an increased risk of AF recurrence after adjusting for other factors.

Conclusion

Pulmonary vein isolation using CB ablation was safe and effective with an acceptable complication and 5-year success rate in a Chinese population with AF, and persistent AF was the independent predictor for 5-year AF recurrence after a single CB ablation procedure.

A young man with irregularly irregular narrow complex tachycardia

Pulmonary vein atrial tachycardia (PVAT) is a rare arrhythmia that accounts for 3% of all atrial tachycardia types. On electrocardiogram, fast PVATs may be misinterpreted as atrial fibrillation at first glance. We present a case of PVAT refractory to pharmacological intervention in a 31-year-old, requiring ablation to terminate the arrhythmia.

Successful cryoballoon ablation of a focal atrial tachycardia in a patient with situs inversus and dextrocardia

Cryoballoon ablation of an arrhythmogenic focus alongside a pulmonary vein as an alternative to radiofrequency ablation may be feasible and safe in patients with situs inversus and dextrocardia.