Abstract

Aims: Catheter ablation of paroxysmal atrial fibrillation (PAF) has been shown to be effective and safe. However, recurrence of PAF varies between 10 and 30% for radiofrequency ablation. There have been no reports comparing long-term recurrence rates following radiofrequency ablation, cryoablation, and three-dimensional guided cryoablation plus radiofrequency ablation. The aim of this study was to observe the long-term recurrence rate of PAF when treated by these three catheter ablation methods, and to explore clinical factors that can potentially predict PAF recurrence following catheter ablation.Methods: There were 238 patients involved in this study, including 106 radiofrequency (RF) ablation cases (RF group), 66 cryoablation cases (Freeze group), and 66 cases treated by three-dimensional guided cryoablation combined with radiofrequency ablation (Freeze-plus-RF group). All patients underwent standardized follow-up. The recurrence rate of atrial fibrillation (AF) in the three groups was calculated. Predictive factors for the recurrence of AF were also investigated.Results: At 48 months (the median follow-up period), the sinus rhythm maintenance rate was 77.4% in the RF group, 72.7% in the Freeze group, and 81.8% in the Freeze-plus-RF group. The maintenance rate of sinus rhythm was highest in the Freeze-plus-RF group, but differences among the three groups were not statistically significant. Further analysis found that the preoperative left atrial appendage emptying velocity (LAAEV) (recurrence vs. no recurrence, 56.58 ± 18.37 vs. 65.59 ± 18.83, respectively, p = 0.003), left atrial (LA) anteroposterior dimension (recurrence vs. no recurrence, 36.56 ± 4.65 vs. 35.00 ± 4.37, respectively; p = 0.028), and LA vertical dimension (recurrence vs. no recurrence, 56.31 ± 6.96 vs. 53.72 ± 6.52, respectively; p = 0.035) were related to postoperative recurrence. Multiple Cox regression analysis showed that only LAAEV was predictive of postoperative recurrence of PAF (hazard ratio: 0.979; 95% confidence interval: 0.961–0.997).Conclusion: Our study found that there was no statistically significant difference in long-term recurrence rates among the RF, Freeze, and Freeze-plus-RF groups. Preoperative LAAEV is an independent predictor of postoperative recurrence of PAF.

Highlights

  • Atrial fibrillation (AF) occurs in 0.71% of the Chinese population aged 35 years or older, and the incidence increases sharply with age [1]

  • The area under the curve was 0.631 (P = 0.005; Figure 2). This is the first study to compare long-term recurrence of paroxysmal atrial fibrillation (PAF) among patients treated by radiofrequency ablation, cryoablation, or cryoablation plus RF

  • Our study found that there were no differences in longterm recurrence among the RF ablation, cryoablation, and cryoablation-plus-RF groups

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Summary

Introduction

Atrial fibrillation (AF) occurs in 0.71% of the Chinese population aged 35 years or older, and the incidence increases sharply with age [1]. In patients who have AF even after medical treatment, catheter ablation is an alternative approach that can reduce complications and improve quality of life [2, 3]. Previous studies have confirmed the effectiveness and safety of catheter ablation in the treatment of paroxysmal atrial fibrillation (PAF) [4,5,6]. In recent years a second method, cryoablation, has become a popular surgical approach for catheter ablation of atrial fibrillation [8]. The PV must be treated for a shorter time with cryoablation than with RCA, and there are fewer postoperative complications [9, 10]. Cryoablation produces a clear boundary, less thrombosis, and a lower incidence of cardiac perforation [11, 12]

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