Multi-catheter cryotherapy compared with radiofrequency ablation in long-standing persistent atrial fibrillation: a randomized clinical trial. Issue 3 (14th November 2020)

• Record Type: Journal Article
• Authors: Gallagher, Mark M; Yi, Gang; Gonna, Hanney; Leung, Lisa W M; Harding, Idris; Evranos, Banu; Bastiaenen, Rachel; Sharma, Rajan; Wright, Sue; Norman, Mark; Zuberi, Zia; Camm, A John
• Is Part Of: Europace. Volume 23:Issue 3(2021)
• Page Start: 370
• Page End: 379
• Publication Date: 2020-11-14
• Subjects: Cryoablation -- Radiofrequency ablation -- Longstanding persistent atrial fibrillation -- Stepwise approach -- Multi-catheter ablation -- Multi-catheter cryoablation; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euaa289
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. Methods and results: Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. Conclusion: Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.