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Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: benefit or wasted time?

  • Malte Kuniss
  • Ersan AkkayaEmail author
  • Alexander Berkowitsch
  • Sergej Zaltsberg
  • Harald Greiss
  • Markus Rechner
  • Kay Weipert
  • Andreas Hain
  • Christian W. Hamm
  • Thomas Neumann
Original Paper
  • 67 Downloads

Abstract

Introduction

It is unknown whether left atrial (LA) roof ablation combined with pulmonary vein isolation (PVI) using a second-generation cryoballoon provides additional benefit beyond that of PVI alone in patients with persistent atrial fibrillation (AF). The aim of this study was to compare arrhythmia recurrence rates after PVI alone versus PVI plus LA roof ablation.

Methods and results

In this observational study, we analyzed 399 symptomatic patients with persistent AF treated with cryoballoon ablation. After univariate and multivariate analyses of the entire cohort, propensity score matching resulted in two groups of 86 patients each: (1) PVI plus LA roof ablation (PVI-plus group) and (2) PVI alone (PVI-only group). The primary endpoint was the first documented > 30-s arrhythmia recurrence after a 3-month blanking period. PVI was successful in all patients. A bidirectional conduction block across the LA roof was verified in 91.9% of patients in the PVI-plus group. During a median mid-term follow-up of 33 months, 21 patients (24.4%) in the PVI-plus group and 37 patients (43.0%) in the PVI-only group (P = 0.01) reached the primary endpoint. Multivariate analysis revealed AF history > 2 years (hazard ratio [HR] = 2.04, P < 0.01), LA area > 21 cm2 (HR = 2.36, P < 0.01), female sex (HR = 1.92, P = 0.02), and LA roof ablation (HR = 0.47, P < 0.01) as significant predictors of outcome.

Conclusions

We observed a significant difference in arrhythmia recurrence rates between the two groups. LA roof ablation is an effective adjuvant treatment option that shows improved outcome compared with PVI alone.

Graphic abstract

Keywords

Left atrial roof ablation Mid-term outcome Persistent atrial fibrillation Roof line Second-generation cryoballoon 

Notes

Funding

There was no funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Malte Kuniss
    • 2
  • Ersan Akkaya
    • 2
    Email author
  • Alexander Berkowitsch
    • 1
  • Sergej Zaltsberg
    • 1
  • Harald Greiss
    • 1
  • Markus Rechner
    • 3
  • Kay Weipert
    • 1
  • Andreas Hain
    • 1
  • Christian W. Hamm
    • 4
  • Thomas Neumann
    • 1
  1. 1.Department of CardiologyKerckhoff Heart CenterBad NauheimGermany
  2. 2.Department of Cardiology and ElectrophysiologyJung Stilling Hospital SiegenSiegenGermany
  3. 3.Department of CardiologyBundeswehrkrankenhausKoblenzGermany
  4. 4.Medical Clinic IJustus-Liebig UniversityGiessenGermany

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