Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo‐LAEF study). (15th April 2019)

• Record Type: Journal Article
• Authors: Giannopoulos, Georgios; Kossyvakis, Charalampos; Vrachatis, Dimitrios; Aggeli, Constadina; Tsitsinakis, Georgios; Letsas, Konstantinos; Tsiachris, Dimitrios; Tsoukala, Styliani; Efremidis, Michalis; Katritsis, Dimosthenis; Deftereos, Spyridon
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 30:Number 7(2019)
• Page Start: 991
• Page End: 998
• Publication Date: 2019-04-15
• Subjects: ablation -- atrial fibrillation -- cryoablation -- emptying fraction -- left atrial ejection fraction; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.13933
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Background: Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function. Methods: Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon. Real‐time three‐dimensional echocardiography was performed (under sinus rhythm in all cases) before ablation and at 1 and 3 months to evaluate the left atrial functional indices. The primary outcome measure was change in left atrial ejection fraction (LAEF) at 1 month. Results: 120 patients were randomized (80 to cryoballoon, 40 to RF). The absolute change in LAEF at 1 month was 4.0 (Q1‐Q3, −0.1to 7.6)% in the cryoballoon group and −0.8 (Q1‐Q3, −1.9 to 0.9)% in the RF group ( P < 0.001 for the comparison between groups). At 3 months, the corresponding changes were 6.7 (Q1‐Q3, 3.4‐11.2)% and 0.7 (Q1‐Q3, −0.7 to 3.5)%, respectively ( P < 0.001). Overall, the rate of patients with lower LAEF at 3 months compared to baseline was 2.5% in the cryoballoon group and 32.5% in the RF group ( P < 0.001). AFib recurrence rate at 6 months was higher in patients with decreased LAEF (odds ratio, 6.2; 95% confidence interval, 2.0‐19.5; P = 0.002). Conclusion: The Cryo‐LAEF study prospectively compared the effects of RF and cryoballoon ablation on left atrial function. Both at 1 and 3 months postablation, LAEF was either improved or stable in both ablation groups.