Title: Combined Use of Cryoablation and Focal Open-Irrigation Ablation for Treatment of Persistent Atrial Fibrillation: Results From a Pilot Study
Topic: Arrhythmias
Date Posted: 4/16/2010
Author(s): Mansour M, Forleo GB, Pappalardo A, et al.
Citation: Heart Rhythm 2010;7:452-458.
Clinical Trial: No
Study Question: How effective is the combination of cryoablation for pulmonary vein isolation (PVI) and radiofrequency ablation (RFA) for substrate modification in patients with persistent atrial fibrillation (AF)?
Methods: Twenty-two patients (mean age 57 years) with persistent AF underwent a three-step ablation procedure: PVI using a 23- or 28-mm cryoballoon; RFA of complex fractionated electrograms; and linear RFA along the roof, mitral isthmus, and septum. Recurrent AF during follow-up was defined as AF/flutter >30 seconds in duration after a 5-week blanking period.
Results: The median duration of cryoablation was 48 minutes and the median procedure time was 262 minutes. The efficacy of the cryoballoon for PVI was 92%. At a mean follow-up of 6 months, 86% of patients were free of recurrent AF. The only complication was transient right phrenic nerve paralysis in 9% of patients.
Conclusions: The combined use of cryoablation and RFA for persistent AF is feasible and has favorable short-term results.
Perspective: The major advantage of cryoablation over RFA is a much lower risk of esophageal injury and PV stenosis. Cryoballoons can achieve PVI with a small number of cryoenergy applications, but substrate modification and linear ablation with cryoenergy would require the use of a focal cryoablation catheter, which is not practical because of extremely long procedure times. The advantages of RFA are the relatively short application times and the ability to create drag lesions. This pilot study demonstrates that cryoablation and RFA can be combined to exploit the respective advantages of the two energy sources. Further studies are needed to compare the combined approach with conventional RFA and to establish long-term efficacy. Fred Morady, M.D., F.A.C.C.
ARMYDA-4 RELOAD Trial
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