open access

Vol 76, No 7 (2018)
Original articles
Published online: 2018-03-07
Submitted: 2017-09-18
Accepted: 2018-03-02
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Cryoballoon ablation of atrial fibrillation in patients with advanced systolic heart failure and cardiac implantable electronic devices

Patrycja Pruszkowska, Radosław Lenarczyk, Jakub Gumprecht, Ewa Jedrzejczyk-Patej, Michał Mazurek, Oskar Kowalski, Adam Sokal, Tomasz Podolecki, Stanisław Morawski, Witold Streb, Katarzyna Mitręga, Zbigniew Kalarus
DOI: 10.5603/KP.a2018.0068
·
Kardiol Pol 2018;76(7):1081-1088.

open access

Vol 76, No 7 (2018)
Original articles
Published online: 2018-03-07
Submitted: 2017-09-18
Accepted: 2018-03-02

Abstract

Background: Pulmonary vein isolation with cryoballoon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF), but in patients with heart failure (HF) the role of CCB remains unknown.

Aim: The aim of the study was to assess the feasibility, effectiveness, and safety of CCB in patients with HF and cardiac im­plantable electronic devices (CIEDs), the impact of the procedure on symptoms, and echocardiographic parameters.

Methods: Thirty consecutive HF patients with left ventricular ejection fraction (LVEF) ≤ 40% and CIED, referred for CCB of AF, were included. Procedural parameters were compared to a group of 59 consecutive patients without cardiac diseases referred for CCB (control group).

Results: The number of veins ablated per patient was smaller and application was performed less frequently in the right inferior pulmonary vein in the HF group compared with the control group (66.7% vs. 88.1%; p = 0.01, respectively). In two (6.7%) patients from the HF group and in five (8.5%) from the control group procedure-related complications occurred (p = 0.76). After six months 21 HF patients (70%), after one year 13 (43%), and after 625 days only three (10%) were free from arrhythmia. AF burden was significantly reduced after six months compared to the pre-ablation period (18.5% vs. 52.9%; p = 0.001). New York Heart Association and European Heart Rhythm Association classes were both significantly (p < 0.001) reduced and LVEF was higher after six months in the HF patients.

Conclusions: Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally nor­mal heart; however, stable positioning of the balloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices.

Abstract

Background: Pulmonary vein isolation with cryoballoon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF), but in patients with heart failure (HF) the role of CCB remains unknown.

Aim: The aim of the study was to assess the feasibility, effectiveness, and safety of CCB in patients with HF and cardiac im­plantable electronic devices (CIEDs), the impact of the procedure on symptoms, and echocardiographic parameters.

Methods: Thirty consecutive HF patients with left ventricular ejection fraction (LVEF) ≤ 40% and CIED, referred for CCB of AF, were included. Procedural parameters were compared to a group of 59 consecutive patients without cardiac diseases referred for CCB (control group).

Results: The number of veins ablated per patient was smaller and application was performed less frequently in the right inferior pulmonary vein in the HF group compared with the control group (66.7% vs. 88.1%; p = 0.01, respectively). In two (6.7%) patients from the HF group and in five (8.5%) from the control group procedure-related complications occurred (p = 0.76). After six months 21 HF patients (70%), after one year 13 (43%), and after 625 days only three (10%) were free from arrhythmia. AF burden was significantly reduced after six months compared to the pre-ablation period (18.5% vs. 52.9%; p = 0.001). New York Heart Association and European Heart Rhythm Association classes were both significantly (p < 0.001) reduced and LVEF was higher after six months in the HF patients.

Conclusions: Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally nor­mal heart; however, stable positioning of the balloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices.

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Keywords

atrial fibrillation, heart failure, pulmonary vein isolation, cryoballoon catheter ablation, cardiac implantable electronic device

About this article
Title

Cryoballoon ablation of atrial fibrillation in patients with advanced systolic heart failure and cardiac implantable electronic devices

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 7 (2018)

Pages

1081-1088

Published online

2018-03-07

DOI

10.5603/KP.a2018.0068

Bibliographic record

Kardiol Pol 2018;76(7):1081-1088.

Keywords

atrial fibrillation
heart failure
pulmonary vein isolation
cryoballoon catheter ablation
cardiac implantable electronic device

Authors

Patrycja Pruszkowska
Radosław Lenarczyk
Jakub Gumprecht
Ewa Jedrzejczyk-Patej
Michał Mazurek
Oskar Kowalski
Adam Sokal
Tomasz Podolecki
Stanisław Morawski
Witold Streb
Katarzyna Mitręga
Zbigniew Kalarus

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