Cryoablation – ABC CARDIOL

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Editorial

Reconnection of Pulmonary Veins After Ablation. A Challenge to be Overcome

Silvia Helena Cardoso Boghossian et al. Ricardo Mourilhe-Rocha

Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and its incidence significantly increases with age.As life expectancy rises, it is estimated that AF prevalence will suffer a significant increase, and its adequate control will continue to be a major challenge.

Until the end of the 90s, the therapeutic options available and most used in the reversion and prevention of AF recurrences were antiarrhythmic drugs (AA) and electrical cardioversion; however, clinical treatment with AA drugs has been shown ineffective in maintaining sinus rhythm, with a recurrence rate above 50%.

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Editorial

The Cold Season Begins in the Tropics. Cryoablation for Atrial Fibrillation in Brazil

Nilson Araújo de Oliveira Junior

Pulmonary vein isolation is the cornerstone for atrial fibrillation ablation. The onset of fibrillation episodes by rapid firing of atrial tachycardias originating from these structures is well documented. The elimination of these triggers by electrical isolation of the pulmonary vein antrum is associated with better arrhythmia control and fewer adverse events, in both the paroxysmal and persistent forms of atrial fibrillation. However, this is not the only mechanism involved, especially in more advanced forms of this arrhythmia. An enormous amount of different ablation techniques has been described to address these other mechanisms. Despite the initial promising results, no other approach has shown effectiveness in large multicenter randomized trials until now.

Obtaining durable pulmonary vein isolation is not a simple task. The standard ablation catheters were designed to ablate a small circumscribed area of cardiac tissue, which is desirable for arrhythmia circuits like Wolff-Parkinson White, but it is a challenge when it is necessary to ablate large areas of complex tridimensional structures, such as the pulmonary vein antrum. The development of non-fluoroscopic navigation, irrigated tips and contact force real-time measurement, among other catheter remarkable improvements, were crucial for the adoption of atrial fibrillation ablation as a routine procedure in clinical electrophysiology. However, ablation with these catheters are still performed by point-by-point lesion deployment.

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Original Article

Experience in a Brazilian Center with Cryoablation for Electric Isolation of the Pulmonary Veins in Paroxysmal and Persistent Atrial Fibrillation – Preliminary Results in Brazil

Silvia Helena Cardoso Boghossian et al. Eduardo C. Barbosa Eduardo Boghossian Lucas Rangel … Paulo Roberto Benchimol-Barbosa Mônica Luiza de Alcantara Marcio Fagundes Alex Felix Ricardo Mourilhe-Rocha

Abstract

Background

Electrical isolation of the pulmonary veins is recognized as the cornerstone of non-pharmacological treatment of Atrial Fibrillation (AF), and therefore, has been recommended as the first step in AF ablation according to all guidelines. Even though the cryoballoon technology is widely used in North America and Europe, this experience is still incipient in many developing countries such as Brazil.

Objective

To evaluate initial results regarding success and safety of the new technology in patients with persistent and paroxysmal AF.

Methods

One hundred and eight consecutive patients with symptomatic AF refractory to pharmacological treatment were submitted to cryoablation for isolation of the pulmonary veins. Patients were separated into two groups according to AF classification: persistent (AF for over one week); or paroxysmal (shorter episodes). Recurrence and procedural safety data were analyzed respectively as primary and secondary outcomes. The level of significance was 5%.

Results

One hundred and eight patients, with mean age 58±13 years, 84 males (77.8%), underwent cryoablation. Sixty-five patients had paroxysmal AF (60.2%) and 43 had persistent AF (39.2%). The mean time of the procedure was 96.5±29.3 minutes and the mean fluoroscopy time was 29.6±11.1 minutes. Five (4.6%) complications were observed, none fatal. Considering a blanking period of 3 months, 21 recurrences (19.4%) were observed in a one-year follow-up period. The recurrence-free survival rates of AF in the paroxysmal and persistent groups were 89.2% and 67.4%, respectively.

Conclusion

Cryoablation for electrical isolation of the pulmonary veins is a safe and effective method for the treatment of AF. Our results are consistent with other studies suggesting that this technology can be used as an initial technique even in cases of persistent AF.

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Reconnection of Pulmonary Veins After Ablation. A Challenge to be Overcome

The Cold Season Begins in the Tropics. Cryoablation for Atrial Fibrillation in Brazil

Experience in a Brazilian Center with Cryoablation for Electric Isolation of the Pulmonary Veins in Paroxysmal and Persistent Atrial Fibrillation – Preliminary Results in Brazil

Abstract

Background

Objective

Methods

Results

Conclusion

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Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)