The impact of left atrium size on selection of the pulmonary vein isolation method for atrial fibrillation: Cryoballoon or radiofrequency catheter ablation

Pulmonary vein isolation (PVI) is the cornerstone of ablation strategies for atrial fibrillation (AF), and noninferiority of cryoballoon (CB) over radiofrequency (RF) ablation has been previously reported. One of the risk factors of recurrence is left atrium (LA) enlargement. This study aimed to ana...

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Published in:The American heart journal Vol. 231; pp. 82 - 92
Main Authors: Ikenouchi, Takashi, Inaba, Osamu, Takamiya, Tomomasa, Inamura, Yukihiro, Sato, Akira, Matsumura, Yutaka, Sato, Hiroyuki, Hirakawa, Akihiro, Takahashi, Yoshihide, Goya, Masahiko, Sasano, Tetsuo, Nitta, Junichi
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.01.2021
Elsevier Limited
Subjects:
Ablation
Aged
Atria
Atrial Fibrillation - surgery
Atrium
Cardiac arrhythmia
Cardiomegaly - complications
Cardiomegaly - diagnostic imaging
Catheter Ablation - methods
Catheters
Clinical outcomes
Cryosurgery - methods
Diameters
Echocardiography
Electrocardiography
Enlargement
Expansion
Female
Fibrillation
Follow-Up Studies
Hazard assessment
Heart Atria - diagnostic imaging
Heart Atria - pathology
Heart failure
Humans
Impact analysis
Male
Medical instruments
Middle Aged
Organ Size
Patients
Postoperative Complications
Propensity Score
Proportional Hazards Models
Pulmonary Veins - diagnostic imaging
Pulmonary Veins - surgery
Radio frequency
Radiofrequency ablation
Recurrence
Retrospective Studies
Risk analysis
Risk Factors
Treatment Outcome
ISSN:0002-8703, 1097-6744, 1097-6744
Online Access:Get full text
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Summary:Pulmonary vein isolation (PVI) is the cornerstone of ablation strategies for atrial fibrillation (AF), and noninferiority of cryoballoon (CB) over radiofrequency (RF) ablation has been previously reported. One of the risk factors of recurrence is left atrium (LA) enlargement. This study aimed to analyze the impact of LA enlargement on the selection of CB or RF ablation for AF patients. A total of 2,224 AF patients (64.4 ± 10.7 years, 65.5% male) who underwent PVI were analyzed retrospectively. Left atrial diameter (LAD) and volume (LAV) were measured using echocardiography before the procedures. LA enlargement was defined as LAD ≥40 mm and LAV index (LAVI) ≥35 mL/m2. Patients undergoing CB and RF ablation were propensity score matched, and 376 matched pairs were evaluated. Cox proportional hazard analysis revealed that LAD (95% CI, 1.01-1.05), LAV (95% CI, 1.01-1.02), and LAVI (95% CI, 1.01-1.03) were independent predictors of recurrence. CB showed equivalent clinical outcomes to those of RF with shorter procedure time required for patients without LA enlargement. CB was inferior to RF in patients with LA enlargement (LAD, 74.5% vs 84.6%, P = .028; LAVI, 74.7% vs 83.4%, P = .015), and large LAVI was associated with a higher prevalence of non-PV foci (35% vs 29%, P = .008). CB ablation may be recommended for patients without enlarged LA based on the short procedure time and efficacy, whereas RF would be more appropriate in large LAs. LAVI may be a valuable reference to predict PVI outcomes and in selecting the ablation method.
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ISSN:0002-8703
1097-6744
1097-6744
DOI:10.1016/j.ahj.2020.10.061