Abstract
Background Catheter ablation combined with left atrial appendage closure (LAAC) was reported as a feasible strategy for atrial fibrillation (AF) patients with high risk of stroke or contraindications of oral anticoagulants. We aimed to observe the short-term safety and efficacy of combining cryoballoon ablation (CBA) with LAAC in paroxysmal (PAF) patients. Method and Results. From Jan 2016 to Dec 2017, 304 patients diagnosed with nonvalvular, drug-refractory PAF were included, who underwent either CBA alone (n = 262) or combined procedure (n = 42). Instant pulmonary vein isolation (PVI) with CBA was achieved in all patients, while successful LAAC achieved in 41 (97.6%) of combined procedure patients. 1-year freedom of AF rate was lower in combined procedure group (84.7% vs 70.7%, p = 0.04), with unadjusted hazard ratio (HR = 1.97) and 95% confidence interval (CI) 1.03–3.77. However, the multivariate COX model revealed left atrial diameter (p = 0.002, HR = 1.10, and 95% CI 1.04, 1.17), rather than procedure type (p = 0.51, HR = 1.34, and 95% CI 0.57, 3.17), was the predictor for freedom of AF. Only 2 patients in the CBA group had stroke, contributing to the nonsignificant higher stroke incidence (p = 1.00). Transoesophageal echochardiography (TEE) achieved in 35 patients (83.3%) showed complete occlusion with no obvious residual flow (>3 mm), Device-related thrombosis, or pericardial perfusion. All-cause mortality, rehospitalization, and complication rates were similar. Conclusion Combining CBA with LAAC in a single procedure is a feasible strategy for PAF patients, with comparable short-term safety and efficacy to CBA alone.
Highlights
Atrial fibrillation (AF) is a commonly faced cardiac arrhythmia, which has been a heavy worldwide burden with a prevalence over 10 million in China [1]
Since the FIRE AND ICE trial provided the evidence of noninferiority of cryoballoon ablation (CBA) to radiofrequency ablation [3], CBA became a pervasive strategy for Catheter ablation (CA) owning to its smooth learning curve and less center experience dependence [4]
paroxysmal AF (PAF) was defined as atrial fibrillation recorded and confirmed either by a 7-day or 24hour ECG monitor, which converted to sinus rhythm spontaneously or by intervention within 7 days [5]
Summary
Atrial fibrillation (AF) is a commonly faced cardiac arrhythmia, which has been a heavy worldwide burden with a prevalence over 10 million in China [1]. Catheter ablation combined with left atrial appendage closure (LAAC) was reported as a feasible strategy for atrial fibrillation (AF) patients with high risk of stroke or contraindications of oral anticoagulants. We aimed to observe the short-term safety and efficacy of combining cryoballoon ablation (CBA) with LAAC in paroxysmal (PAF) patients. Instant pulmonary vein isolation (PVI) with CBA was achieved in all patients, while successful LAAC achieved in 41 (97.6%) of combined procedure patients. 1-year freedom of AF rate was lower in combined procedure group (84.7% vs 70.7%, p 0.04), with unadjusted hazard ratio (HR = 1.97) and 95% confidence interval (CI) 1.03–3.77. Combining CBA with LAAC in a single procedure is a feasible strategy for PAF patients, with comparable short-term safety and efficacy to CBA alone
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