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Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?
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Abstract
Background: Relation between pre-procedural selection of patients and the success rate after a single cryoballoon ablation (CAB) procedure is unknown.
Methods: CAB was performed in 378 (65% male, median age 58 years, 85% paroxysmal atrial fibrillation [AF]) consecutive patients with symptomatic and drug refractory AF. The combined ALARMEc (Atrial fibrillation type, Left Atrium size, Renal insufficiency, Metabolic syndrome, cardiomyopathy) risk score was calculated for each individual patient. The end-point of the study was the first AF, atrial flutter or atrial tachycardia recurrence after the 3-month blanking period in the 1-year follow-up since the index procedure, in the absence of anti-arrhythmic (class I and III) therapy.
Results: Single and multi-catheter approach was used in 79% and 21% of patients, respectively. The acute success rate with single and multi-catheter approach was 79% and 99%, respectively. The overall 1-year success rate after a single CAB procedure was 70%. The 1-year outcome was: 83%, 70%, 60%, 40% and 29% in patients with ALARMEc risk score: 0, 1, 2, 3 and 5, respectively. Total rate of complications was 11%, including transient phrenic nerve palsy in 9.5% of cases.
Conclusions: Multi-catheter approach was needed in 21% of patients to achieve acute pulmonary vein isolation. Patients with low (≤ 1) ALARMEc risk score, preferably young individuals with sole paroxysmal AF (ALARMEc = 0), are best candidates for CBA procedure. Performing CBA in patients with higher (> 2) ALARMEc risk score should be avoided. Phrenic nerve palsy was a transient complication.
Abstract
Background: Relation between pre-procedural selection of patients and the success rate after a single cryoballoon ablation (CAB) procedure is unknown.
Methods: CAB was performed in 378 (65% male, median age 58 years, 85% paroxysmal atrial fibrillation [AF]) consecutive patients with symptomatic and drug refractory AF. The combined ALARMEc (Atrial fibrillation type, Left Atrium size, Renal insufficiency, Metabolic syndrome, cardiomyopathy) risk score was calculated for each individual patient. The end-point of the study was the first AF, atrial flutter or atrial tachycardia recurrence after the 3-month blanking period in the 1-year follow-up since the index procedure, in the absence of anti-arrhythmic (class I and III) therapy.
Results: Single and multi-catheter approach was used in 79% and 21% of patients, respectively. The acute success rate with single and multi-catheter approach was 79% and 99%, respectively. The overall 1-year success rate after a single CAB procedure was 70%. The 1-year outcome was: 83%, 70%, 60%, 40% and 29% in patients with ALARMEc risk score: 0, 1, 2, 3 and 5, respectively. Total rate of complications was 11%, including transient phrenic nerve palsy in 9.5% of cases.
Conclusions: Multi-catheter approach was needed in 21% of patients to achieve acute pulmonary vein isolation. Patients with low (≤ 1) ALARMEc risk score, preferably young individuals with sole paroxysmal AF (ALARMEc = 0), are best candidates for CBA procedure. Performing CBA in patients with higher (> 2) ALARMEc risk score should be avoided. Phrenic nerve palsy was a transient complication.
Keywords
atrial fibrillation, cryoballoon ablation, outcome, selection of patients
About this articleTitle
Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?
Journal
Issue
Pages
194-200
Published online
2015-04-28
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1931
Article views/downloads
2031
DOI
10.5603/CJ.a2014.0100
Pubmed
Bibliographic record
Cardiol J 2015;22(2):194-200.
Keywords
atrial fibrillation
cryoballoon ablation
outcome
selection of patients
Authors
Maciej Wójcik
Alexander Berkowitsch
Sergey Zaltsberg
Christian W. Hamm
Heinz F. Pitschner
Malte Kuniss
Thomas Neumann
