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
Summary
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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