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Comparing cryoballoon and contact-force guided radiofrequency ablation in pulmonary vein isolation for atrial fibrillation in patients with hypertrophic cardiomyopathy

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Pulmonary vein isolation (PVI) employing cryoballoon (CB) or contact force-guided radiofrequency (CF-RF) catheter ablation has been established as an effective strategy for managing atrial fibrillation (AF). However, its efficacy in hypertrophic cardiomyopathy (HCM) remains to be further explored.

Methods

This retrospective study analyzed 60 consecutive AF patients with HCM (average age 67 ± 10 years; 41 men) who were consecutively admitted to our hospital from January 2014 to December 2022 and underwent initial PVI.

Results

The patients were treated with CB (26 patients) or CF-RF (34 patients). Successful PVI was achieved in both groups without significant complications. In the CF-RF group, additional ablations were performed on the cavotricuspid isthmus (14.7% of patients) and the anterior line (2.9%). The CB group benefited from reduced procedural times (93 ± 31 vs. 165 ± 60 min, p < 0.05) and decreased saline irrigation requirements (77.5 ± 31.4 vs. 870 ± 281.9 mL, p < 0.0001). Using a contrast medium was exclusive to the CB group (33.8 ± 4.2 mL). In a 12-month follow-up, the atrial tachyarrhythmia recurrence-free rates in the CB and CF-RF groups were comparable (77% and 76%, respectively; p = 0.63 according to the log-rank test). Notably, pulmonary vein reconnection was prevalent in most (7 out of 8) patients requiring a secondary ablation procedure.

Conclusion

PVI is feasible as a strategy for AF in patients with HCM employing either CB or CF-RF techniques. While the recurrence-free rates were comparable in both groups, differences were noted in procedure duration, saline usage, and the need for a contrast medium.

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Data Availability

The data supporting the findings of this study are available on reasonable request from the corresponding author.

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Acknowledgements

The authors thank Ms. Kaori Aoki, Mr. Keigo Yamamoto, and Mr. Yuuki Suzuki in the Department of Clinical Engineering, Hirosaki University Hospital, for their technical assistance in the electrophysiological study. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This research received no specific grant from public, commercial, or not-for-profit funding agencies.

Author information

Authors and Affiliations

  1. Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Takahiko Kinjo, Daisuke Horiuchi, Kimitaka Nishizaki, Yuichi Toyama, Shogo Hamaura, Shingo Sasaki & Hirofumi Tomita

  2. Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

    Masaomi Kimura, Taihei Itoh, Shingo Sasaki & Hirofumi Tomita

  3. Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Yuji Ishida, Shingo Sasaki & Hirofumi Tomita

  4. Department of the Advanced Therapeutics for Cardiovascular Diseases, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Hirofumi Tomita

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  1. Takahiko Kinjo
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Contributions

Daisuke Horiuchi conceived the idea of the study. Takahiko Kinjo conducted statistical analyses and drafted the original manuscript. Masaomi Kimura decided on a treatment strategy for ablation and supervised the conduct of this study. All authors contributed to the interpretation and analysis of the results, reviewed and revised the manuscript draft, and approved the final version for submission.

Corresponding author

Correspondence to Masaomi Kimura.

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Conflict of interest disclosure

Dr. Masaomi Kimura is an associate professor, and Dr. Taihei Itoh is an associate professor/lecturer of the Department of Advanced Management of Cardiac Arrhythmias, which is an endowment Department supported by Medtronic Japan Co., Ltd., Japan Lifeline Co., Ltd, and Fukuda Denshi Kita-Tohoku Hanbai Co., Ltd. Dr. Yuji Ishida is an assistant professor of the Department of Cardiac Remote Management System, which is an endowment Department supported by BIOTRONIK Japan Co., Ltd. Dr. Shingo Sasaki received a research grant from Boston Scientific Japan Co., Ltd. and is a concurrent associate professor of the Department of Advanced Management of Cardiac Arrhythmias and the Department of Cardiac Remote Management System. Dr. Hirofumi Tomita is a concurrent professor of the Department of Advanced Management of Cardiac Arrhythmias, the Department of Cardiac Remote Management System, and the Department of the Advanced Therapeutics for Cardiovascular Diseases, which is an endowment Department supported by Boston Scientific Japan Co., Ltd. Dr. Tomita also received a research grant from Abbott Medical Japan LLC. Other authors have no relevant disclosures.

Ethics approval

In this retrospective cohort study, an opt-out consent approach was adopted to uphold patient autonomy while accommodating the study’s retrospective nature of the study. The study was approved by the Committee of Medical Ethics of Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Reference number: 2023 − 163) and was conducted in accordance with the principles of the Helsinki Declaration.

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Kinjo, T., Kimura, M., Horiuchi, D. et al. Comparing cryoballoon and contact-force guided radiofrequency ablation in pulmonary vein isolation for atrial fibrillation in patients with hypertrophic cardiomyopathy. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01822-x

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