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Outcomes following cryoballoon ablation for atrial fibrillation guided by pressure waveform monitoring without the routine use of pulmonary venography

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Pressure waveform analysis has the potential for facilitated assessment of pulmonary vein occlusion during cryoballoon ablation for atrial fibrillation. Data on clinical outcomes using this method are lacking. We sought to validate through clinical outcomes the use of pressure waveform analysis as the primary method of determining pulmonary vein occlusion during cryoballoon ablation.

Methods

A study was performed of 122 consecutive patients with atrial fibrillation (85% paroxysmal) undergoing cryoballoon ablation from May 2014 through July 2015 at a single institution using pressure waveform analysis as the primary method of assessing pulmonary vein occlusion.

Results

Cryoballoon ablation, with additional segmental radiofrequency ablation in 13.7%, resulted in complete pulmonary vein isolation in 100% of patients. The single procedure freedom from recurrence of atrial arrhythmia beyond the initial 3-month post-ablation was 81.2% at a mean follow-up of 237 days. Recurrence of atrial arrhythmia within 3-month post-ablation was 11.1%, and predicted recurrence beyond 3 months. Repeat ablation was performed in 12.0% of patients.

Conclusions

In the largest study to date on this topic and the only study to focus on clinical outcomes, pressure waveform analysis as the primary method of determining pulmonary vein occlusion in cryoballoon ablation of atrial fibrillation resulted in acute and long-term procedural success rates comparable to those reported with use of routine pulmonary venography. Controlled study is needed to confirm these findings and to determine if this technique affects variables such as procedure duration and radiation exposure.

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Authors and Affiliations

  1. Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA

    Akshit Sharma, Jashdeep Dhoot, Jingyan Wang, Philip Jones, Sanjaya Gupta & Alan P. Wimmer

  2. Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA

    Jingyan Wang, Philip Jones, Sanjaya Gupta & Alan P. Wimmer

Authors
  1. Akshit Sharma
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  2. Jashdeep Dhoot
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  3. Jingyan Wang
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  4. Philip Jones
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  5. Sanjaya Gupta
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  6. Alan P. Wimmer
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Corresponding author

Correspondence to Alan P. Wimmer.

Ethics declarations

The Institutional Review Board at this hospital approved the study protocol.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained according to institutional standards for the clinically indicated procedures the patients included in this retrospective study underwent. For this type of study, formal consent for the study itself is not required.

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Sharma, A., Dhoot, J., Wang, J. et al. Outcomes following cryoballoon ablation for atrial fibrillation guided by pressure waveform monitoring without the routine use of pulmonary venography. J Interv Card Electrophysiol 49, 75–82 (2017). https://doi.org/10.1007/s10840-017-0249-3

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  • DOI: https://doi.org/10.1007/s10840-017-0249-3

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