Preventing atrial fibrillation by combined right isthmus ablation and cryoballoon pulmonary vein isolation in patients with typical atrial flutter: PAF‐CRIOBLAF study

Journal of Arrhythmia

Michael Bubenheim ScD¹  Jacques Mansourati²  Antoine Milhem³  Serge Boveda⁴  Olivier Cesari⁵  Pascal Defaye⁶  Alexis Mechulan⁷  Gilles Lande⁸  Jean‐Pierre Cebron⁹  Philippe Rivat^1,10  Dominique Pavin^1,11  Arnaud Savouré^1,12  Frédéric Anselme^1,12  Laurence Jesel^1,13  Nicolas Clémenty^1,14 

[1] Department of Biostatistics Rouen University Hospital Rouen France;Department of Cardiology Brest University Hospital Boulevard Tanguy Prigeant Brest France;Department of Cardiology Centre hospitalier de La Rochelle La Rochelle France;Department of Cardiology Clinique Pasteur Toulouse France;Department of Cardiology Clinique Saint‐Gatien Tours France;Department of Cardiology Grenoble‐ Alpes University Hospital Grenoble France;Department of Cardiology Hôpital privé de Clairval Marseille France;Department of Cardiology Nantes University Hospital Nantes France;Department of Cardiology Nouvelles Cliniques Nantaises Nantes France;Department of Cardiology Polyclinique Vauban Valenciennes France;Department of Cardiology Rennes University Hospital Rennes France;Department of Cardiology Rouen University Hospital Rouen France;Department of Cardiology Strasbourg University Hospital Strasbourg France;Department of Cardiology Tours University Hospital Tours France;

关键词: ablation techniques;    atrial fibrillation;    atrial flutter;    cryoablation;    pulmonary veins;   

DOI  :  10.1002/joa3.12626

来源: DOAJ

【 摘 要 】

Abstract Background Although less common, typical atrial flutter shares similar pathophysiological roots with atrial fibrillation. Following successful cavo‐tricuspid isthmus ablation using radiofrequency, many patients, however, develop atrial fibrillation in the mid‐to‐long‐term. This study sought to assess whether pulmonary vein isolation conducted at the same time as cavo‐tricuspid isthmus ablation would significantly modify the atrial fibrillation burden upon follow‐up in patients suffering from typical atrial flutter. Methods This was a multicenter randomized controlled study involving typical atrial flutter patients with history of non‐predominant atrial fibrillation (1 atrial fibrillation episode only, in 67% of population) who were scheduled for cavo‐tricuspid isthmus radiofrequency ablation. Patients were randomly assigned to either undergo cavo‐tricuspid isthmus ablation alone or cavo‐tricuspid isthmus plus pulmonary vein isolation (CTI+). Pulmonary vein isolation was performed using cryoballoon technology. An outpatient consultation with ECG and 1‐week Holter monitoring was performed at 3, 6 months, 1 year, and 2 years postprocedure. The primary endpoint was atrial fibrillation recurrences lasting more than 30 s at 2 years postablation. Results Of the patients enrolled, 36 were included in each group. At 2‐year follow‐up, the atrial fibrillation recurrence rate was significantly higher in the CTI vs CTI+group (25/36, 69% vs. 12/36, 33% respectively; P < .001), with similar typical atrial flutter recurrence rates. There were no differences in undesirable events, except for transient phrenic nerve palsy reported from three CTI+patients (8.3%). Conclusion Pulmonary vein isolation using cryoballoon technology was proven to significantly reduce the atrial fibrillation incidence at 2 years postcavo‐tricuspid isthmus ablation.

【 授权许可】

Unknown