Cryoablation plus focal radiofrequency ablation associated with favorable short-term outcomes

Issue: May 2010

Cryoablation for pulmonary vein isolation combined with focal radiofrequency left atrial substrate ablation was associated with improved short-term outcomes, results from a pilot study suggested.

Researchers from Boston and Rome included 22 consecutive patients with persistent atrial fibrillation and assigned each to pulmonary vein isolation using a cryoablation balloon and focal radiofrequency ablation for treatment. Vein isolation was initially performed using cryoablation, followed by the use of radiofrequency ablation for the treatment of left atrial complex fractionated atrial electrograms. Patients were assigned to esophagus–gastroduodenal evaluation within 48 hours of the procedure, and follow-up outpatient clinic visits were scheduled at one month, three months and every three months thereafter.

According to the results, 82 pulmonary veins were targeted and isolated. Among those, 77 (94%) were completed using cryoablation, and five (6%) required radiofrequency energy to complete vein isolation. The researchers reported a mean of 9.7 ± 2.6 cryoablation applications per patient were needed for pulmonary vein isolation, with a median required time per vein of 600 seconds. AF persisted after the procedure in 19 (86%) of patients. Left atrial complex fractionated atrial electrograms that persisted after cryoablation were ablated using radiofrequency energy. At a mean follow-up of 6.0 ± 2.9 months, 86.4% of patients were free of AF without antiarrhythmic drugs.

“The results of this pilot study demonstrate that a combined approach of cryoablation and radiofrequency ablation for persistent AF is feasible and associated with a favorable short-term and midterm outcome,” the researchers concluded. “Randomized studies in larger cohorts of patients are required to determine the safety and efficacy of this approach.”

Mansour M. Heart Rhythm. 2010;7:452-458.