Kryoballon ile Tek Merkezde Atriyal Fibrilasyon Ablasyonu Deneyimi

Öz

Giriş: Pulmoner venlerin elektriksel izolasyonu, atriyal fibrilasyonun (AF) invaziv tedavisinin temel taşı olarak bilinir ve bu nedenle, AF ablasyonunda ilk adım olarak önerilmiştir. Bu çalışmada, persistant ve paroksismal AF tanısı koyulan hastalarda pulmoner ven izolasyonu (PVI) deneyimimizi ve klinik sonuçlarımızı analiz ettik. Metodoloji: Antiaritmik tedaviye dirençli semptomatik AF'si olan ardışık yüz altı hastaya pulmoner venlerin izolasyonu için kriyoablasyon uygulandı. Hastalar AF sınıflamasına göre persistant veya paroksismal olmak üzere iki gruba ayrıldı. Rekürrens ve peri-prosedürel komplikasyonlar sırasıyla birincil ve ikincil sonuçlar olarak analiz edildi. Bulgular: Yaş ortalaması 51.8 ±13.1 yıl, 67’si erkek (%63.2) olan 106 hastaya kriyoablasyon tedavisi uygulandı. 90 hastada paroksismal AF (%84.9) ve 16 hastada persistant AF (%15.1) vardı. Ortalama işlem süresi 115,9±9,1 dakika ve ortalama floroskopi süresi 29,2±5,6 dakikaydı. Ölümcül olmayan 8 (%7.5) komplikasyon gözlendi. İşlem sonrası 3 aylık dönem çıkarıldığında ortalama 25.2 aylık takip süresinde 18 nüks (%17) gözlendi. Paroksismal ve persistan gruplarda AF'nin nükssüz oranları sırasıyla %85.6 ve %61.8’idi. Sonuç: Kriyobalon ile pulmoner ven izolasyonu AF tedavisinde başarılı ve güvenilir bir yöntem olarak görünmektedir. Sonuçlarımız, kriyoablasyonun persistant AF'si olan hastalarda bile başlangıç tekniği olarak kullanılabileceğini gösteren önceki çalışmalarla uyumludur.

Anahtar Kelimeler

• Atriyal fibrilasyon
• Kryoballoon
• Frenik sinir paralizisi

A Single Center Experience of Atrial Fibrillation Ablation with Cryoballon

Abstract

Background: Electrical isolation of the pulmonary veins is known as the fundamental of for atrial fibrillation (AF) treatment invasively, and thus, has been suggested as the first-line therapy in AF curation. In this study, we presented our single center pulmonary vein isolation (PVI) experience and long-term clinical outcome. Methods: One hundred and six symptomatic AF patients resistant to medical therapy underwent cryoablation of the pulmonary veins. Participants were divided into two groups regarding AF categorization as persistent or paroxysmal. Recurrence and peri-procedural complications were evaluated after the treatment. Results: A 106 patients, 67 males (63.2%), with mean age of 51.8 ±13.1 years, underwent cryoablation. While the paroxysmal AF group was composed of 90 patients (84.9%); the persistent AF group consisted of 16 patients (15.1%). The procedure mean time was 115,9±9,1 minute while the fluoroscopy mean time was 29,2±5,6 minutes. A total of 8 (7.5%) non-fatal complications were experienced. A total of 18 recurrences (17%) were observed during mean duration of 25.2 months follow-up period. The survival rates without AF were 85.6% and 61.8 % in in the paroxysmal and persistent groups, respectively. Conclusion: The cryoballoon PVI seems to be a successful and reliable method of treating AF and may be preferred as a primary procedure even in patients with persistent AF.

Keywords

• Atrial fibrillation
• Cryoballon
• Phrenic nerve palsy

Kaynakça

1. 3- Kirchhof P, Benussi S, Kotecha D, et al. 2016 Esc Guidelines for the management of atrial fibrilation developed in collaboration with EACTS. Europace. 2016;18(11):1609-78.
2. 4- Wong KC, Paisey JR, Sopher M, et al. No benefit of complex fractionated atrial electrogram ablation in addition to circunferential pulmonary vein ablation and linear ablation: benefit of complex ablation study. Circ Arrhythm Electrophysiol. 2015;8(6):1316-24.
3. 5- Fink T, Schlüter M, Heeger CH, et al. Stand-alone pulmonary vein isolation versus pulmonary vein isolation with additional substrate modification as index ablation procedures in patients with persistent and long standing persistent atrial fibrillation: the Randomized Alster-Lost-AF Trial (Ablation at St Georg Hospital for long standing persistent atrial fibrillation). Circ Arrhythm Electrophysiol. 2017;10(7):pii:e005114.
4. 6- Franceschi F, Koutbi L, Mancini J, et al. Novel electromyographic monitoring technique for prevention of right phrenic nerve palsy during cryoballoon ablation. Circ Arrhythm Electrophysiol. 2013; 6:1109-1114. doi:10.1161/CIRCEP.113.000517.
5. 7- Chierchia GB, Di Giovanni G, Ciconte G, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up. Europace. 2014 May;16(5):639-44. doi: 10.1093/europace/eut417.
6. 8- Fürnkranz A, Bordignon S, Dugo D, et al. Improved 1-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2014 Aug;25(8):840-844. doi: 10.1111/jce.12417.
7. 9- Ciconte G, Ottaviano L, de Asmundis C, et al. Pulmonary vein isolation as index procedure for persistent atrial fibrillation: One-year clinical outcome after ablation using the second-generation cryoballoon. Heart Rhythm. 2015 Jan;12(1):60-6. doi: 10.1016/j.hrthm.2014.09.063.
8. 10- Lemes C, Wissner E, Lin T, et al. One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis. Europace. 2016 Feb;18(2):201-5. doi:10.1093/europace/euv092.

9. 11- Andrade JG, Champagne J, Deyell MW, et al. A randomized clinical trial of early invasive intervention for atrial fibrillation (EARLY-AF) methods and rationale. Am Heart J 2018;206:94-104. doi: 10.1016/j.ahj.2018.05.020.
10. 12- Jais P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 2008;118:2498-2505. doi: 10.1161/CIRCULATIONAHA.108.772582.
11. 13- Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA 2010;303:333-340. doi: 10.1001/jama.2009.2029.
12. 14- Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 2012;367:15871595. doi:10.1056/NEJMoa1113566.
13. 15- Blomstrom-Lundqvist C, Gizurarson S, Schwieler J, et al. Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial. JAMA 2019;321(11):1059-1068. doi:10.1001/jama.2019.0335.
14. 16- Mark DB, Anstrom KJ, Sheng S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA 2019;321(13):1275-1285. doi:10.1001/jama.2019.0692.
15. 17- Shi LZ, Heng R, Liu SM, et al. Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: a meta-analysis of randomized controlled trials. Exp Ther Med 2015;10:816-822. doi: 10.3892/etm.2015.2545.
16. 18- Kuck K-H , Brugada J, Fürnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016;9;374(23):2235-45. doi: 10.1056/NEJMoa1602014.
17. 19- Tamborero D, Mont L, Berruezo A, et al. Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation: a prospective randomized study. Circ Arrhythm Electrophysiol 2009;2:35-40. doi:10.1161/CIRCEP.108.797944.
18. 20- Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 2015;372:1812-1822. doi: 10.1056/NEJMoa1408288.
19. 21- Arbelo E, Guiu E, Ramos P, et al. Benefit of left atrial roof linear ablation in paroxysmal atrial fibrillation: a prospective, randomized study. J Am Heart Assoc 2014;3:e000877. doi:10.1161/JAHA.114.000877.
20. 22- Da Costa A, Levallois M, Romeyer-Bouchard C, et al. Remote-controlled magnetic pulmonary vein isolation combined with superior vena cava isolation for paroxysmal atrial fibrillation: a prospective randomized study. Arch Cardiovasc Dis 2015;108:163-171. doi: 10.1016/j.acvd.2014.10.005.
21. 23- Hu X, Jiang J, Ma Y, et al. Is there still a role for additional linear ablation in addition to pulmonary vein isolation in patients with paroxysmal atrial fibrillation? An updated meta analysis of randomized controlled trials. Int J Cardiol 2016;209:266-274. doi:10.1016/j.ijcard.2016.02.076.
22. 24- Vizzardi E, Curnis A, Latini MG, et al. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown). 2014 Mar;15(3):235-53. doi: 10.2459/JCM.0b013e328358554b.
23. 25- Boghossian SHC, Barbosa EC, Boghossian E, et al. Experience in a Brazilian Center with Cryoablation for Electric Isolation of the Pulmonary Veins in Paroxysmal and Persistent Atrial Fibrillation - Preliminary Results in Brazil. Arq Bras Cardiol. 2020 Sep;115(3):528-535. English, Portuguese. doi: 10.36660/abc.20200320
24. 26- Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial. Circulation. 2019 Nov 26;140(22):1779-1788. doi:10.1161/CIRCULATIONAHA.119.042622
25. 27- Heeger CH, Wissner E, Mathew S, et al. Once Isolated, Always Isolated? Incidence and Characteristics of Pulmonary Vein Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol. 2015 Oct;8(5):1088-94. doi: 10.1161/CIRCEP.115.003007.
26. 28- Reddy VY, Sediva L, Petru J, et al. Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) Study. J Cardiovasc Electrophysiol. 2015 May;26(5):493-500. doi: 10.1111/jce.12626.
27. 29- Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45. doi: 10.1056/NEJMoa1602014.
28. 30- Tondo C, Iacopino S, Pieragnoli P, et al. Pulmonary vein isolation cryoablation for patients with persistent and long-standing persistent atrial fibrillation: Clinical outcomes from the real-world multicenter observational project. Heart Rhythm. 2018 Mar;15(3):363-368. doi:10.1016/j.hrthm.2017.10.038.
29. 31- Kuck KH, Fürnkranz A, Chun KR, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J. 2016 Oct 7;37(38):2858-2865. doi: 10.1093/eurheartj/ehw285.
30. 32- Mörtsell D, Arbelo E, Dagres N, et al. Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry. Europace. 2019 Apr 1;21(4):581-589. doi: 10.1093/europace/euy239.
31. 33- Boveda S, Metzner A, Nguyen DQ, et al. Single-Procedure Outcomes and Quality-of-Life Improvement 12 Months Post-Cryoballoon Ablation in Persistent Atrial Fibrillation: Results From the Multicenter CRYO4PERSISTENT AF Trial. JACC Clin Electrophysiol. 2018 Nov;4(11):1440-1447. doi: 10.1016/j.jacep.2018.07.007.
32. 34- Providencia R, Defaye P, Lambiase PD, et al. Results from a multicentre comparison of cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: is cryoablation more reproducible? Europace. 2017 Jan;19(1):48-57. doi: 10.1093/europace/euw080.