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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation.

Florian Straube1,2, Janis Pongratz1, Alexander Kosmalla1

  • 1Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.

Frontiers in Cardiovascular Medicine
|December 6, 2021
PubMed
Summary

Cryoballoon ablation (CBA) is effective for treating persistent atrial fibrillation (AF) in initial procedures. This study shows CBA is a reasonable strategy with good outcomes and manageable complications for persistent AF patients.

Keywords:
atrial fibrillationcatheter ablationcryoballoon ablationpersistent atrial fibrillationpulmonary vein isolation

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Cryoballoon ablation (CBA) is a standard treatment for paroxysmal atrial fibrillation (AF).
  • Persistent AF requires evaluation of CBA as an initial ablation strategy.

Purpose of the Study:

  • To assess the efficacy and safety of CBA for pulmonary vein isolation (PVI) in patients with symptomatic persistent AF undergoing their first ablation procedure.
  • To evaluate technical improvements, safety, outcomes, recurrence predictors, and PVI durability with CBA.

Main Methods:

  • Prospective evaluation of 1,140 patients with symptomatic persistent AF undergoing cryoballoon PVI between 2007 and 2020.
  • Assessment of technical enhancements, laboratory management, safety, single-procedure outcomes, recurrence predictors, and PVI durability.
  • Analysis of major complications, recurrence rates, and pulmonary vein reconduction, comparing early and advanced CBA generations.

Main Results:

  • Acute PVI was achieved in 99.6% of pulmonary veins.
  • Major complications occurred in 1.5% of patients; no atrio-esophageal fistulas were observed.
  • One- and two-year freedom from atrial arrhythmias was 81.8% and 61.7%, respectively, with recurrence predictors including LA diameter and female sex.
  • Use of advanced CBA generations improved PVI durability, reducing reconduction rates significantly.

Conclusions:

  • Cryoballoon ablation is a viable and effective strategy for the initial treatment of symptomatic persistent AF.
  • Technical advancements and the use of advanced CBA generations enhance procedural efficiency and long-term outcomes.
  • CBA offers a safe and reasonable approach for persistent AF, with a need for continued monitoring and potential repeat procedures.