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Second-generation cryoballoon effective in patients with persistent AF
Most patients with persistent atrial fibrillation who had pulmonary vein isolation with a second-generation cryoballoon did not have recurrent atrial fibrillation after almost a year, according to the results of a new study.
Researchers performed pulmonary vein isolation using a second-generation cryoballoon (Arctic Front Advance, Medtronic) on 393 pulmonary veins in 100 patients (mean age, 63 years; 80% men) who had symptomatic persistent AF despite taking at least one antiarrhythmic drug.
Patients were followed up for a mean of 10.6 months at outpatient clinics, during which they underwent Holter ECG. The primary outcome was recurrent AF, defined as a symptomatic or documented arrhythmia episode lasting more than 30 seconds after a 3-month blanking period.
Buelent Koektuerk, MD, from the department of cardiology/electrophysiology at Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany, and colleagues reported a mean procedural time of 96.2 minutes and mean fluoroscopy time of 19.7 minutes, with no periprocedural deaths or cerebrovascular events. Phrenic nerve palsy occurred in 3% of patients.
At the end of the follow-up period, 67% of patients were in sinus rhythm. According to the researchers, 24% of patients had AF recurrence during the 3-month blanking period. Those who had AF recurrence during the blanking period were more likely than those who did not to have late AF recurrence (45.5% vs. 13.4%; P = .001), and the only independent predictor of late AF recurrence was AF recurrence during the blanking period (HR = 3.83; 95% CI, 1.91-7.68), they wrote.
Of the 67 patients who did not have AF recurrence after the blanking period, only four were still using antiarrhythmic drugs at the end of follow-up.
“These findings in such a large patient group are compatible with the data regarding better efficacy with this novel cryoballoon,” Koektuerk and colleagues wrote. “Different from previous studies, [left atrium] size was not found to be a significant predictor of outcome in our study population. This might be due to the characteristics of the study population enrolled in our analysis.” – by Erik Swain
Disclosure: Koektuerk reports consulting for Medtronic. The other researchers report no relevant financial disclosures.