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Posterior box isolation as an adjunctive ablation strategy with the second-generation cryoballoon for paroxysmal atrial fibrillation: a comparison with standard cryoballoon pulmonary vein isolation

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Abstract

Purpose

The purpose of the study was to evaluate the impact of left atrial posterior wall isolation (LAPWI) in addition to pulmonary vein isolation (PVI) vs PVI alone, performed using CB-A, in patients with PAF on a midterm follow-up of 12 months.

Methods

Eighty consecutive patients indicated to index cryoballoon ablation (CB-A) for the treatment of drug resistant PAF were included. The first 50 (62.5%) underwent PVI only, and the following 30 patients (37.5%) underwent LAPWI + PVI.

Results

Acute isolation was achieved in all PVs in both groups. The LAPW was successfully isolated in 29 out of 30 (97%) patients; in the remaining patient, adjunct radiofrequency ablation was required. The total procedure time and the mean fluoroscopy time were significantly shorter in patients who underwent PV isolation only (p < 0.001).

The freedom from atrial fibrillation (AF) at 12 months was not significantly different between the 2 groups (LAPW + PVI = 90% vs PVI = 88%) (log-rank p = 0.816).

Conclusion

LAPW ablation in addition to PVI by the means of CB-A does not seem to reduce the risk of AF recurrence if compared with the standard PVI on a midterm follow-up of 12 months.

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Author notes

  1. Antonio Bisignani and Ingrid Overeinder contributed equally to this work.

Authors and Affiliations

  1. Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Course in Cardiac Electrophysiology and Pacing, European Refernce Networks Guard-Heart, Vrije Universiteit, Brussels, Belgium

    Antonio Bisignani, Ingrid Overeinder, Shuichiro Kazawa, Saverio Iacopino, Federico Cecchini, Vincenzo Miraglia, Thiago Guimarães Osório, Serge Boveda, Gezim Bala, Giacomo Mugnai, Cinzia Monaco, Erwin Ströker, Pedro Brugada, Juan Sieira, Alessio Galli, Carlo de Asmundis & Gian Battista Chierchia

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  1. Antonio Bisignani
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  2. Ingrid Overeinder
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Corresponding author

Correspondence to Gian Battista Chierchia.

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Conflict of interest

S.B. is consultant for Medtronic, Boston Scientific, and MicroPort. C.d.A. reports speaker fees for Medtronic, Biotronik, Biosense Webster, Abbott, and Boston Scientific; teaching honoraria from Medtronic, Biotronik, Abbott, and Boston Scientific; and proctoring honoraria from Medtronic, Abbott, and Biotronik. G.B.C. reports speaker fees for Medtronic, Biotronik, Biosense Webster, and Abbott; teaching honoraria from Medtronic and Biotronik; and proctoring honoraria from Medtronic. P.B. reports consulting fees and speaker honoraria from Medtronic.

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Bisignani, A., Overeinder, I., Kazawa, S. et al. Posterior box isolation as an adjunctive ablation strategy with the second-generation cryoballoon for paroxysmal atrial fibrillation: a comparison with standard cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol 61, 313–319 (2021). https://doi.org/10.1007/s10840-020-00812-z

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  • DOI: https://doi.org/10.1007/s10840-020-00812-z

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