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Important factors in left atrial posterior wall isolation using 28‐mm cryoballoon ablation for persistent atrial fibrillation—Block line or isolation area?
Author(s) -
Nanbu Tadafumi,
Yotsukura Akihiko,
Suzuki George,
Ishidoya Yuki,
Sano Fumihiko,
Yoshida Izumi,
Sakurai Masayuki
Publication year - 2020
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.14281
Subject(s) - medicine , ablation , atrial fibrillation , sinus rhythm , hazard ratio , pulmonary vein , cardiology , catheter ablation , block (permutation group theory) , confidence interval , surgery , geometry , mathematics
Left atrial (LA) roof ablation using the cryoballoon technique, combined with pulmonary vein isolation (PVI), has been reported to be beneficial for ablation therapy in patients with persistent atrial fibrillation (AF). Left posterior wall ablation also results in improved patient outcomes. However, the contribution of these techniques to the success of cryoballoon ablation (CBA) treatment of AF is not known. The present study examined the influence of the roofline block and isolation area on outcomes after CBA. Methods and Results We enrolled 78 patients with persistent AF. LA roof ablation was performed using a 28‐mm cryoballoon with a single freezing of 3 minutes at each region (median number of freezes: 4) after PVI. After CBA, bipolar voltage amplitude mapping was performed during sinus rhythm using the NavX mapping system. Patients were divided into two subgroups according to the voltage and activation map: the roof‐conduction (n = 46) and roofline‐block groups (n = 32). Atrial tachyarrhythmia recurred in 20 patients of the conduction group and 4 patients of the roofline‐block group. The rate of 12‐month freedom from tachyarrhythmia after a single ablation procedure was 78% (95% confidence interval [CI], 60%‐89%) in the roofline‐block group and 45% (95% CI, 30%‐60%) in the conduction group ( P = .048). Cox proportional hazard analysis revealed that the isolated area was not a significant predictor of recurrence (hazard ratio, 0.94; 95% CI, 0.86‐1.02; P = .15). Conclusion Creating a complete roofline block is the major factor predicting the maintenance of sinus rhythm in patients with persistent AF.