Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation in hemodialysis patients.

Abstract

INTRODUCTION:

Little evidence exists regarding cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (PAF) in hemodialysis (HD) patients. We compared CBA and radiofrequency ablation (RFA) of PAF in HD patients, referring to CBA of PAF in non-HD patients.

METHODS AND RESULTS:

This historical cohort study examined 88 patients who underwent catheter ablation of PAF, including 21 HD patients with a second-generation 28-mm cryoballoon (CB-HD group), 17 HD patients with a non-force-sensing radiofrequency catheter (RF-HD group), and 50 non-HD patients with a cryoballoon (CB-non-HD group). Pulmonary vein (PV) isolation alone aside from cavotricuspid isthmus ablation was performed in 14 (67%) in the CB-HD group, 12 (71%) in the RF-HD group, and 36 (72%) in the CB-non-HD group (P = 0.95), without isoproterenol-induced non-PV triggers. Non-PV trigger ablation was added to the other patients. The Kaplan-Meier estimated 1-year freedom from atrial tachyarrhythmia recurrence without antiarrhythmic drugs after a single procedure was 76%, 59%, and, 92% in the CB-HD, RF-HD, and CB-non-HD groups, respectively (P = 0.002). The mean procedure time was shorter in the CB-HD group than in the RF-HD group (127 vs. 199 min; P < 0.001). In the second procedure, the median number of reconnected pulmonary veins was 0.5 in the CB-HD group versus 2.0 in the RF-HD group (P = 0.17).

CONCLUSION:

For PAF in HD patients, CBA showed a comparable single-procedure efficacy to that of RFA with a short procedure time. CBA may be a reasonable initial procedure for HD patients suffering from symptomatic PAF.

• Authors: Tomomasa Takamiya, Junichi Nitta, Osamu Inaba, Akira Sato, Yukihiro Inamura, Nobutaka Kato, Kazuya Murata, Takashi Ikenouchi, Toshikazu Kono, Giichi Nitta, Yutaka Matsumura, Yoshihide Takahashi, Masahiko Goya, Tetsuo Sasano
• Journal: Heart and vessels (Heart Vessels) Vol. 35 Issue 12 Pg. 1709-1716 (Dec 2020) ISSN: 1615-2573 [Electronic] Japan
• PMID: 32524235 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Atrial Fibrillation (diagnosis, physiopathology, surgery)
• Catheter Ablation (adverse effects)
• Cryosurgery (adverse effects)
• Female
• Humans
• Kidney Diseases (diagnosis, physiopathology, therapy)
• Male
• Middle Aged
• Operative Time
• Pulmonary Veins (physiopathology, surgery)
• Recurrence
• Renal Dialysis (adverse effects)
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome