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Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: benefit or wasted time?

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Abstract

Introduction

It is unknown whether left atrial (LA) roof ablation combined with pulmonary vein isolation (PVI) using a second-generation cryoballoon provides additional benefit beyond that of PVI alone in patients with persistent atrial fibrillation (AF). The aim of this study was to compare arrhythmia recurrence rates after PVI alone versus PVI plus LA roof ablation.

Methods and results

In this observational study, we analyzed 399 symptomatic patients with persistent AF treated with cryoballoon ablation. After univariate and multivariate analyses of the entire cohort, propensity score matching resulted in two groups of 86 patients each: (1) PVI plus LA roof ablation (PVI-plus group) and (2) PVI alone (PVI-only group). The primary endpoint was the first documented > 30-s arrhythmia recurrence after a 3-month blanking period. PVI was successful in all patients. A bidirectional conduction block across the LA roof was verified in 91.9% of patients in the PVI-plus group. During a median mid-term follow-up of 33 months, 21 patients (24.4%) in the PVI-plus group and 37 patients (43.0%) in the PVI-only group (P = 0.01) reached the primary endpoint. Multivariate analysis revealed AF history > 2 years (hazard ratio [HR] = 2.04, P < 0.01), LA area > 21 cm2 (HR = 2.36, P < 0.01), female sex (HR = 1.92, P = 0.02), and LA roof ablation (HR = 0.47, P < 0.01) as significant predictors of outcome.

Conclusions

We observed a significant difference in arrhythmia recurrence rates between the two groups. LA roof ablation is an effective adjuvant treatment option that shows improved outcome compared with PVI alone.

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Funding

There was no funding for this study.

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Author notes

  1. Malte Kuniss and Ersan Akkaya have contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany

    Malte Kuniss, Alexander Berkowitsch, Sergej Zaltsberg, Harald Greiss, Markus Rechner, Kay Weipert, Andreas Hain, Christian W. Hamm & Thomas Neumann

  2. Department of Cardiology and Electrophysiology, Jung Stilling Hospital Siegen, Wichernstr. 40, 57074, Siegen, Germany

    Ersan Akkaya

  3. Department of Cardiology, Bundeswehrkrankenhaus, Koblenz, Germany

    Markus Rechner

  4. Medical Clinic I, Justus-Liebig University, Giessen, Germany

    Christian W. Hamm

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  1. Malte Kuniss
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Correspondence to Ersan Akkaya.

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Conflict of interest

Prof. Thomas Neumann and Dr. Malte Kuniss have received honoraria from Medtronic as invited speakers and for advisory board activities. Other authors declare that they have no conflict of interest.

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Kuniss, M., Akkaya, E., Berkowitsch, A. et al. Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: benefit or wasted time?. Clin Res Cardiol 109, 714–724 (2020). https://doi.org/10.1007/s00392-019-01560-5

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  • DOI: https://doi.org/10.1007/s00392-019-01560-5

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