Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: Predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences

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• 作者：Giacomo Mugnai ; MD^* ; ^{mugnai.giacomo@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Carlo de Asmundis ; MD ; PhD ; FHRS^* ; Burak Hü ; nü ; k ; MD^* ; Erwin Strö ; ker ; MD^* ; Vedran Velagic ; MD^* ; Darragh Moran ; MD^* ; Diego Ruggiero ; MD^* ; Ebru Hacioglu ; MD^* ; Jan Poelaert ; MD ; PhD^&dagger ; ; Christian Verborgh ; MD ; PhD^&dagger ; ; Vincent Umbrain ; MD ; PhD^&dagger ; ; Stefan Beckers ; MD ; PhD^&dagger ; ; Hugo Enrique Coutino-Moreno ; MD^* ; Ken Takarada ; MD^* ; Pedro Brugada ; MD ; PhD^* ; Gian-Battista Chierchia ; MD ; PhD^*
• 关键词：Second-generation cryoballoon ; Pulmonary vein isolation ; Blanking period ; Early recurrence ; Atrial fibrillation
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：13
• 期：4
• 页码：845-851
• 全文大小：386 K

文摘

Although consensus documents on catheter and surgical ablation of atrial fibrillation (AF) suggest a uniform “blanking period” of 3 months, recent evidence suggested that early recurrences of atrial tachyarrhythmias (ERATs) are strongly associated with late recurrences (LRs), especially if ERATs occurred in the last part of the “blanking period”.

Objective

The present study sought to assess the role of ERATs in predicting LRs in a large cohort of patients with paroxysmal AF who have undergone second-generation cryoballoon ablation.

Methods

Consecutive patients with drug-resistant paroxysmal AF who underwent pulmonary vein isolation using CB-A technology as the index procedure were retrospectively included in our analysis. The exclusion criteria were any contraindications for the procedure, including the presence of an intracavitary thrombus, uncontrolled heart failure, contraindications to general anesthesia, and persistent AF.

Results

A total of 331 consecutive patients (104 women [31%]; mean age 56.7 ± 13.3 years) were enrolled. Atrial tachyarrhythmias/AF recurrences were detected in 57 patients (17.2%). The highest prevalence of ERATs was observed in the first 2 weeks (55%) after pulmonary vein isolation. Of note, all the ERATs occurring 1.5 months after AF ablation relapsed after 3 months and were confirmed as definitive recurrences. Late recurrence of AF and atrial tachycardia occurred in 20 of 29 patients with ERATs (69.0%) and 28 of 302 patients without ERATs (9.3%) (P < .0001). A multivariate Cox regression analysis showed that the early recurrence within the blanking period was significantly and independently associated with an increased risk of developing a late recurrence (hazard ratio 6.79; 95% confidence interval 3.52–10.14; P < .0001).

Conclusion

Our findings reveal that ERATs are strongly associated with an LR after paroxysmal AF ablation using CB-A technology (hazard ratio 6.79; 95% confidence interval 3.52–10.14; P < .0001). Of note, when ERATs occurred later than 1.5 months, patients systematically experienced an LR.