Optimal single procedure strategy of pulmonary vein isolation with
cryoballoon or radiofrequency and non-pulmonary vein triggers ablation
for non-paroxysmal atrial fibrillation
Abstract
Introduction: Limited data exist on pulmonary vein isolation (PVI) using
cryoballoon (CB) or radiofrequency (RF) ablation and additional
non-pulmonary vein triggers ablation for non-paroxysmal atrial
fibrillation (non-PAF). The objective of this study was to assess the
outcomes of first-stage catheter ablation for non-PAF patients. Methods
and Results: Initial PVI was performed on 734 non-PAF patients (age:
64±10 years; male: 584) between September 2014 and June 2018 [315
(43%), CB ablation; 419 (57%), RF catheter]. A logistic regression
model was used to match 257 pairs (514 patients) according to propensity
scores (CB group or RF group). After PVI, additional non-PV triggers
ablation was performed if induced by isoproterenol. We analyzed the
clinical outcomes of both groups. The mean procedural time was
significantly shorter in the CB group (125 [range, 89–165] min)
than in the RF group (190 [160–224] min; P < 0.001). The
1-year Kaplan-Meier event rate revealed similar atrial fibrillation-free
survival rate between the groups (CB: 77.9%, RF: 82.3%; log-rank P =
0.111). The additional ablation percentage for non-PV foci (CB: 39%,
RF: 41%; P = 0.653) and the complications incidence (CB: 5%, RF: 4%;
P = 0.670) were also similar. Conclusion: In non-PAF patients, PVI using
CB or RF ablation and non-PV triggers ablation achieved comparable
outcomes. The safety and efficacy of the combination strategy of PVI and
non-PV triggers ablation was demonstrated.