Cryoballoon ablation of atrial fibrillation in low and medium volume hospitals – experiences of the German REGIONAL registry

Background

Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established and widespread procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at low and medium volume hospitals is unknown.

Aim

To determine safety and acute efficacy of PVI using CBA performed at community hospitals with limited annual case numbers.

Methods

This registry study prospectively included 1004 consecutive patients who underwent PVI with CBA for symptomatic paroxysmal (n=563) or persistent AF (n=441) between 01/2019 and 09/2020 at 20 community hospitals (each performing <100 PVI/year). Qualifying criteria for participating hospitals were an experience of performing CBA for at least 1 year and a minimum of 50 CBA performed up to the start of the registry. All CBA procedures were performed according to the individual local standards of each hospital. Procedural data, acute efficacy and complications were determined.

Results

The mean annual number of CBA procedures performed was 59±26/hospital, the mean annual number of PVI performed regardless of the method used was 70±26/center. 8/20 hospitals performed CBA only. There were 22 operators (1,1/center), in 12/20 hospitals CBA was performed by an operator being board certified in invasive electrophysiology. 10/20 hospitals included <60 patients/center (n=381), the centers enrolling >60 patients/hospital included a total of 623 pts (62%). Mean procedure time was 90.1±31.6 min, mean fluoroscopy time was 19.2±11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients. Not achieving the goal of “all veins isolated” in a respective patient was mainly due to early termination of CBA procedure due to phrenic nerve palsy.

Major complications occurred in 1,2% of patients: no in-hospital death (0%), clinical stroke in 2 patients (0.2%), pericardial effusion requiring pericardial drainage in 2 patients (0,2%), vascular complications needing vascular surgery and/or blood transfusion in 2 patients (0,2%), phrenic nerve palsy persisting up to hospital discharge in 6 patients (0,6%). Minor complications occurred in 7,5% of patients: pericardial effusion with no need of intervention in 0,4%, access site complications with no need for therapeutic intervention or prolonged in-hospital stay in 2,1% (mainly superficial hematoma) and phrenic nerve palsy resolving before discharge in 4,2%.

No significant difference in the number of complications could be found when testing for numbers of enrolled patients (> or < than 60/hospital) or regarding the board certification status of the operator.

Conclusions

PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high acute efficacy and low complication rates despite low and moderate annual procedure numbers.

Funding Acknowledgement

Type of funding sources: None.

Safety and efficacy of cryoballoon-ablation for atrial fibrillation performed at local hospitals: results of the german register on cryoballoon-ablation in local hospitals (REGIONAL)

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

REGIONAL

Background

Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at community hospitals with low to moderate case numbers is unknown.

Aim

To determine safety and efficacy of PVI using CBA performed at community hospitals with limited annual case numbers.

Methods

1004 PVI performed consecutively between 01/2019 and 09/2020 at 20 community hospitals (each <100 PVI using CBA/year) for symptomatic paroxysmal AF (n = 563) or persistentAF (n= 441) were included in this registry. CBA was performed considering local standards. Procedural data, efficacy and complications were determined.

Results

Mean number of PVI using CBA/year was 59 ± 26. Mean procedure time was 90.1 ± 31.6 min and mean fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients, early termination of CBA due to phrenic nerve palsy was the most frequent reason for incomplete isolation. There was no in-hospital death. 2 patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in 6 patients (0.6%), 2 of them (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), in 2 of these patients (0.2%) vascular surgery was required. In 48 patients (4.8 %) phrenic nerve palsy was noticed which persisted up to hospital discharge in 6 patients (0.6%).

Conclusions

PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high efficacy and low complication rates despite low to moderate annual procedure numbers.

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[Diagnostic methods in the bulbus duodeni. Agreement and disagreement between endoscopic, roentgenological and histological examinations (author's transl)]

In a collective of 1012 patients (700 m., 312 f.), 346 (268 m., 78 f.) had pathological endoscopic findings in the bulbus. Diseases of the bulbus appeared in women about 10 years later than in men. In comparison to the endoscopic findings, roentgen findings showed disagreement in about 35% which mainly arose from contradictions in the assessment of cicatricial changes in the bulbus. False negative ulcer findings amounted to about 21%, the false positive to 19%. Endoscopic and histologically confirmed malignancies were not overlooked in a single case.