Author + information
- Michelle Silvera,b,
- Jordan Kinga,b,
- Frederick Hana,b,
- Gagandeep Kaura,b,
- Christian Mahnkopfa,b and
- Nassir Marrouchea,b
Background: Cryoballoon systems used for pulmonary vein isolation ablation of atrial fibrillation (AF) increase ability to deliver consistent contact force, thereby reducing gaps between ablation lesions. The DECAAF study showed that left atrial (LA) fibrosis not covered by ablation scar predicts recurrence. We hypothesized that targeting LA fibrosis with cryoablation would lead to improved success rates with cryoablation.
Methods: Late gadolinium enhancement (LGE) MRI was used to quantify baseline LA fibrosis. AF patients with Utah Stage 1 (<10%) or 2 (10-20%) LA fibrosis underwent cryoablation with ablation targeting LA fibrosis. Patients were followed until recurrence, last encounter, or 1 year post-ablation, whichever occurred first. Recurrence was defined as detection of AF, following a 90-day blanking period. We assessed the impact of AF type on outcomes using a Cox proportional hazards model.
Results: This study cohort included 125 patients (68.8% male; mean age 63.1 ± 10.2); the majority presented with Utah 2 (75.2%) and paroxysmal AF (79.2%). 33 patients (26.4%) experienced recurrence over a median follow-up of 118 days [IQR: 97 – 252]. Cox models displayed no significant differences in risk of recurrence between persistent and paroxysmal AF (HR 1.19, [95% CI, 0.55 – 2.57], p = .65).
Conclusions: Cryoballoon ablation targeting LA has equivalent success rates for paroxysmal and persistent AF. This substrate-based approach to ablation may improve patient selection and subsequent outcomes.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Basic 5
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1281-115
- 2017 American College of Cardiology Foundation