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Comparison of advanced generation cryoballoon ablation and ablation index-guided pulmonary vein isolation with non-pulmonary vein trigger induction test and additional ablation in paroxysmal atrial fibrillation

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Abstract

Background

An ablation index (AI)-guided pulmonary vein isolation (PVI) or 2nd generation cryoballoon (CB)-PVI has been shown to reduce the atrial fibrillation (AF) burden by 99% despite the absence of ablation of non-pulmonary vein (PV) triggers in patients with paroxysmal AF. The purpose of this study was to investigate the effects of PVI alone strategy using 2nd generation CB compared with AI-guided PVI with an additional induction test and subsequent AF trigger ablation.

Methods and results

We investigated 223 patients with symptomatic paroxysmal AF who underwent an initial PVI between August 2018 and August 2020. The study patients were divided into 2 groups: CB-PVI without an induction test (CB-PVI alone group, n = 82) and AI-guided PVI with an induction test and subsequent additional ablation of non-PV triggers (AI-PVI plus group, n = 141). In the AI-PVI plus group, a total of 62 non-PV triggers were induced in 38 patients, and non-PV triggers in 22 patients were completely ablated. The procedure time and left atrium dwell time were significantly shorter in the CB-PVI alone group than AI-PVI plus group. There were no significant differences in the incidence of procedural complications between the 2 groups (P = 0.650). The AF free survival rate in the CB-PVI alone group and AI-PVI plus group was 80% vs. 80% at 24 months (P = 0.969).

Conclusions

An PVI alone strategy using advanced generation CB did not differ in the clinical outcomes compared with an AI-guided PVI strategy with an induction test and subsequent ablation of non-PV triggers in the patients with paroxysmal AF.

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Data availability

The datasets analyzed in this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank all the medical staff at Osaka Rosai Hospital for their technical support and John Martin for his linguistic support.

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Authors and Affiliations

  1. Department of Cardiology, Osaka Rosai Hospital, 3-1179, Nagasone-Cho, Sakai, Osaka, 591-8025, Japan

    Yasuyuki Egami, Masami Nishino, Hiroaki Nohara, Shodai Kawanami, Hiroki Sugae, Kohei Ukita, Akito Kawamura, Hitoshi Nakamura, Koji Yasumoto, Masaki Tsuda, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masamichi Yano & Jun Tanouchi

Authors
  1. Yasuyuki Egami
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Contributions

All authors substantially contributed to the work and met the authorship criteria as follows:

Conception and design or analysis and interpretation of the data: Yasuyuki Egami, Hiroaki Nohara, Shodai Kawanami, Hiroki Sugae, Kohei Ukita, Akito Kawamura, Hitoshi Nakamura, and Koji Yasumoto.

Drafting of the manuscript or revising it critically for its important intellectual content: Yasuyuki Egami, Masaki Tsuda, Naotaka Okamoto, Yasuharu Matsunaga-Lee, and Masamichi Yano.

Final approval of the manuscript submitted: Masami Nishino and Jun Tanouchi.

Corresponding author

Correspondence to Masami Nishino.

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This study protocol was approved by the Institutional Ethics Committee at the Osaka Rosai Hospital.

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Egami, Y., Nishino, M., Nohara, H. et al. Comparison of advanced generation cryoballoon ablation and ablation index-guided pulmonary vein isolation with non-pulmonary vein trigger induction test and additional ablation in paroxysmal atrial fibrillation. J Interv Card Electrophysiol 66, 1571–1580 (2023). https://doi.org/10.1007/s10840-022-01459-8

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