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The clinical impact of the left atrial posterior wall lesion formation by the cryoballoon application for persistent atrial fibrillation: Feasibility and clinical implications
Author(s) -
Nishimura Takuro,
Yamauchi Yasuteru,
Aoyagi Hideshi,
Tsuchiya Yusuke,
Shigeta Takatoshi,
Nakamura Rena,
Yamashita Mitsumi,
Asano Mitsutoshi,
Nakamura Tomofumi,
Suzuki Hidetoshi,
Shimura Tsukasa,
Kurabayashi Manabu,
Keida Takehiko,
Sasano Tetsuo,
Hirao Kenzo,
Okishige Kaoru
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13879
Subject(s) - medicine , atrial fibrillation , sinus rhythm , cardiology , pulmonary vein , lesion , surgery
The left atrial (LA) posterior wall (LAPW) has been targeted to improve the clinical outcomes in patients with persistent atrial fibrillation (PersAF). This study aimed to investigate the feasibility, safety, and clinical implications of cryoballoon (CB) applications on the LAPW to accomplish electrical isolation (EI) of the LAPW with CB. Methods A total of 100 patients (males, 84; mean age, 64 ± 10 years) with PersAF were enrolled. The first 50 patients underwent only pulmonary vein isolation (PVI) (PVI‐only group) and the remaining 50 patients underwent PVI and EI of the LAPW with CB (EI‐LAPW group). Results One‐year sinus rhythm maintenance probability was significantly higher in the EI‐LAPW group than in PVI‐only group (80.0% vs 55.1%, P = 0.01). The success rate of constructing an LA roof block line (LA‐RB), bottom block line, and EI of the LAPW was 92%, 60%, and 58%, respectively. The nadir CB temperature (−45°C ± 4°C vs −39°C ± 5°C, P = 0.005) and anatomical angle of the left atrial roof (106°C ± 30°C vs 144°C ± 17°C, P < 0.001) significantly predicted the successful LA‐RB construction. The left ventricular ejection fraction was significantly higher in unsuccessful cases than in successful cases of an EI of the LAPW (64% ± 8% vs 58% ± 11%, P = 0.041). Even though the EI of the LAPW was unsuccessful, CB freezing in LAPW significantly debulked the nonscar area (≥0.1 mV) in LAPW (18.1 ± 5.6 vs 2.2 ± 3.1 cm 2 , P < 0.001) and provided the equivalent 1‐year outcome of successful cases (79.3% vs 81.0%, P = 0.90). Conclusion The combination of PVI and EI of the LAPW with CB provided better clinical outcomes than conventional PVI procedure for patients with PersAF.