Oosterhaven, J.A.F. (2013) Efficacy and safety of irrigated tip radio-frequency catheter ablation, multi-electrode duty cycled radio-frequency ablation, cryoballoon ablation and laserballoon ablation in the treatment of symptomatic paroxysmal and persistent atrial fibrillation. thesis, Medicine.
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Abstract
Background: Studies have shown that paroxysmal atrial fibrillation (AF) might arise from the repetitive firing of myocytes in muscle sleeves that extend from the left atrium (LA) into the pulmonary veins (PVs). Using catheter ablation to isolate the PVs from the LA is an accepted approach to treat paroxmal AF in addition to pharmacological management. Recurrence of AF after pulmonary vein isolation (PVI) is an important issue. In the majority of patients, recurrence of AF is caused by reconnection of the PVs after initial ablative therapy. Furthermore, risks and complications associated with PVI are being studied. Over the past decade, a number of catheters and techniques have been developed in order to optimise the procedure. Objective: Aim of this study was to compare outcomes of ablation with an irrigated tip radio-frequency (RF) ablation catheter, ablation with a non-irrigated multi-electrode radio-frequency pulmonary vein ablation catheter (PVAC), ablation by freezing of the tissue using a cryoballoon (CRYO) and ablation using laser energy with an endoscopically guided laserballoon catheter (LASER). Specifically, we investigated short- and mid-term efficacy and safety of the different strategies. Methods: From a retrospective registry, 618 patients with symptomatic paroxysmal or persistent AF, referred for primo PVI, were identified. In this registry, 4 different treatment approaches were investigated: ablation with irrigated RF (n = 318), PVAC (n = 230), CRYO (n = 37) or LASER (n = 33). Mean age was 56.7 ± 10.1 years; 74.3% were male. The number of paroxysmal AF subjects was 252 in the RF group, 193 in the PVAC group, 27 in the CRYO group and 28 in the LASER group. Patients had a history of symptomatic AF with a mean duration of 7.6 ± 5.1 years. There were no significant baseline differences between the groups. Primary endpoints were freedom from AF regardless of antiarrhythmic drug (AAD) therapy after 6 and 12 months and the occurrence of periprocedural and post procedural complications, within 30 days post PVI. Results: Median follow up duration was 311 days (interquartile range 91-531). There was no significant difference in freedom of AF off antiarrythmic drug therapy after 6 months between RF (67.8%), PVAC (75.5%), CRYO (62.5%) and LASER (100.0%) (P = 0.146). Procedure time in minutes was significantly lower in the PVAC group compared with RF, CRYO and LASER (134 ± 39 vs. 175 ± 46, 193 ± 41 and 238 ± 46; P = < 0.001). Fluoroscopy time was significantly shorter in the RF group compared to PVAC, CRYO and LASER (28 ± 12 vs. 32 ± 12, 44 ± 15 and 37 ± 11; P < 0.01). Temporary phrenic nerve paralysis occured significantly more in the CRYO group, compared to RF and PVAC (8.6% vs. 0% in both groups; P < 0.01). Vascular access complications were significantly lower in the PVAC group, compared to RF, CRYO and LASER (2.3% vs. 7.8%, 9.4% and 8.6%; P < 0,01). Conclusion: 6 months post PVI, no statistical difference in terms of efficacy was found between RF, PVAC, CRYO and LASER in the treatment of symptomatic paroxysmal and persistent atrial fibrillation. Proceduretime was shortest in PVAC ablation. Fluoroscopytime was shortest in the irrigated RF group. Temporary phrenic nerve paralysis occurred more in the CRYO group. PVAC was associated with the least vascular access complications.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Elvan, A. MD |
| Supervisor name: | Gal, P. MD and Department of Cardiology and Isala Klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1725 |
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