Tachycardia Incidence After Radiofrequency vs Cryoballoon PVI
Tachycardia Incidence After Radiofrequency vs Cryoballoon PVI
Atrial Tachycardia Incidence After RF versus Cryoballoon PVI. Background: Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation (PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.
Objective: To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).
Methods: All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA-AT) based on invasive mapping procedure findings and ECG P-wave morphology.
Results: The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow-up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA-AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow-up was 3.5%.
Conclusion: In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.
Pulmonary vein isolation (PVI) with radiofrequency (RF) ablation is an increasingly frequent treatment for atrial fibrillation (AF) and is performed in many major hospitals worldwide. However, postablation atrial tachycardia (AT) is a significant complication as it is often more symptomatic than index arrhythmia and is difficult to treat either pharmacologically or with electrical cardioversion, thus frequently requiring a repeat ablation procedure. Although some of the ATs may be cavotricuspid isthmus (CTI)-dependent flutter, especially in patients without a previous CTI ablation, a large proportion is localized to the left atrium (LA) and thought to be mainly related to gaps in ablation lines. The reported incidence of postablation ATs ranges from <5% to 50% with an increased risk when AF duration is prolonged and additional lines are added during the index ablation procedure. Cryoballoon (CB) ablation, using a "single application," is a widely adopted alternative technique for PVI that appears to have a low incidence of ATs during follow-up, although information is limited and no direct comparison with RF ablation has been published. We compared the incidence and characteristics of ATs after sole circumferential PVI ablation, with no additional ablation lines or ablation of complex fractionated atrial electrograms (CFAE), with CB ablation in patients with paroxysmal AF.
Abstract and Introduction
Abstract
Atrial Tachycardia Incidence After RF versus Cryoballoon PVI. Background: Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation (PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.
Objective: To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).
Methods: All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA-AT) based on invasive mapping procedure findings and ECG P-wave morphology.
Results: The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow-up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA-AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow-up was 3.5%.
Conclusion: In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.
Introduction
Pulmonary vein isolation (PVI) with radiofrequency (RF) ablation is an increasingly frequent treatment for atrial fibrillation (AF) and is performed in many major hospitals worldwide. However, postablation atrial tachycardia (AT) is a significant complication as it is often more symptomatic than index arrhythmia and is difficult to treat either pharmacologically or with electrical cardioversion, thus frequently requiring a repeat ablation procedure. Although some of the ATs may be cavotricuspid isthmus (CTI)-dependent flutter, especially in patients without a previous CTI ablation, a large proportion is localized to the left atrium (LA) and thought to be mainly related to gaps in ablation lines. The reported incidence of postablation ATs ranges from <5% to 50% with an increased risk when AF duration is prolonged and additional lines are added during the index ablation procedure. Cryoballoon (CB) ablation, using a "single application," is a widely adopted alternative technique for PVI that appears to have a low incidence of ATs during follow-up, although information is limited and no direct comparison with RF ablation has been published. We compared the incidence and characteristics of ATs after sole circumferential PVI ablation, with no additional ablation lines or ablation of complex fractionated atrial electrograms (CFAE), with CB ablation in patients with paroxysmal AF.
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