1. The predictive role of early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation. Is blanking period an outdated concept? Insights from 12-month continuous cardiac monitoring.
- Author
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Davtyan KV, Topchyan AH, Brutyan HA, Kalemberg EN, Kharlap MS, Simonyan GY, Kalemberg AA, and Kuznetsova MV
- Subjects
- Action Potentials, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Female, Heart Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Pulmonary Veins physiopathology, Recurrence, Reproducibility of Results, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Atrial Fibrillation surgery, Cryosurgery adverse effects, Electrocardiography, Ambulatory instrumentation, Pulmonary Veins surgery, Remote Sensing Technology instrumentation
- Abstract
Background: Early recurrences of atrial arrhythmias (ERAA) after atrial fibrillation (AF) catheter ablation do not predict procedural failure. A well-demarcated homogeneous lesion delivered by cryoballoon is less arrhythmogenic, and the recommended three-months blanking period may not refer to cryoballoon ablation (CBA)., Objective: We aimed to evaluate the predictive role of ERAA after second-generation CBA using an implantable loop recorder., Methods: This prospective observational study enrolled 100 patients (58 males, median age 58) with paroxysmal/persistent AF undergoing pulmonary vein (PV) CBA using second-generation cryoballoon with simultaneous ECG loop recorder implantation. The duration of follow-up was 12 months, with scheduled visits at 3, 6 and 12 months., Results: 99 patients from 100 completed the 12-month follow-up period. ERAA occurred in 31.3 % of patients. 83.9 % of patients with ERAA also developed late recurrences. The 12-month freedom from AF in patients with ERAA was significantly lower than in those without ERAA (p < 0.0001). Non-paroxysmal AF and longer arrhythmia history were associated with increased risk of both early (HR 3.27; 95 % CI 1.32-8.08; p = 0.010 and HR 1.0147; 95 % CI 1.008-1.086; p = 0.015, respectively) and late recurrences (HR 3.89; 95 % CI 1.67-9.04; p = 0.002 and HR 1.0142; 95 % CI 1.007-1.078; p = 0.019, respectively) of AF. ERAA were another predictor for procedural failure (HR 15.2; 95 % CI (6.42-35.99; p = 0.019)., Conclusions: ERAA occurred in the third of the patients after PV second-generation CBA and are strongly associated with procedural failure. Longer duration of AF history and persistent AF are independent predictors of AF's early and late recurrence., (© 2021. The Author(s).)
- Published
- 2021
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