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Rapid Pulmonary Vein Firing Does Not Predict AF Ablation Outcome in Persistent AF
Abstracts
332 Radiation Exposure During Atrial Fibrillation (AF) Ablation Utilising Cryoballoon Technology J. Hayes 1 , W. Stafford 1 , I. Smith 2 , H. Mattson 3 , A. Van Der Meer 4,∗ 1 Queensland Cardiovascular Group, Brisbane, Australia 2 St Andrew’s War Memorial Hospital, Brisbane, Australia 3 Medtronic, Minneapolis, USA 4 Medtronic, Sydney, Australia
Background: Recent advances in technology have had a significant impact on the electrophysiology-based treatment of atrial fibrillation (AF). Main areas of impact involve radiation risk and procedure time. We evaluate use of cryoablations compared to conventional radiofrequency (RF) ablation procedures. Methods: Details for 292 consecutive patients undergoing index AF ablation were captured into a single-centre registry. Radiation, procedural and outcome data for three ablation techniques were compared: RF ablation with (30) and without (59) the anti-scatter grid (RF Grid and RF Gridless) and cryoballoon ablation (203) utilising the first and second generation Medtronic Arctic Front Cryoballoons (Cryo). The dose area product (DAP; Gy cm2) was adjusted for a standardised patient weight of 80 kg. Results/Discussion: DAP was significantly higher for RF Grid (7.31) than the Cryo (2.09) and RF Gridless groups (3.11). DAP for Cryo was significantly lower than RF Gridless (p < 0.001). Similarly, fluoroscopy time (FT) was significantly different between Cryo and RF Gridless cohorts (13.1 vs. 16.8 min; p < 0.001) as were the procedure times (85 min vs. 146 min; p < 0.001), respectively. There was no significant difference in procedural outcome and complication rates between the three approaches. Conclusion: Cryoballoon technology offers a viable means of significantly improving the efficiency of index AF ablations. Significant reductions in radiation exposure and procedure time while maintaining safety and efficacy were achieved. http://dx.doi.org/10.1016/j.hlc.2017.06.333
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333 Rapid Pulmonary Vein Firing Does Not Predict AF Ablation Outcome in Persistent AF S. Prabhu 1,∗ , M. Kalla 2 , A. Voskoboinik 1 , A. Mclellan 1 , K. Peck 1 , B. Pathik 2 , C. Nalliah 2 , G. Wong 2 , S. Azzopardi 1 , G. Lee 2 , J. Mariani 1 , L. Ling 1 , A. Taylor 1 , J. Kalman 2 , P. Kistler 1 1 Alfred
Health/Baker Heart and Diabetes Institute, Melbourne, Australia 2 Royal Melbourne Hospital, Melbourne, Australia Introduction: PVI remains the cornerstone of catheter ablation (CA) in persistent AF (PeAF) although less successful than for PAF. Rapid PV firing may identify PeAF patients more likely to benefit from a PV based approach. We sought to evaluate the relationship between PVCL and outcome following CA for PeAF. Methods: Prior to ablation for peAF, PV cycle length (PVCL) was recorded with a multipolar catheter in each PV and the left atrial appendage (LAA) for 100 consecutive cycles. For each patient, the average PVCL of all 4 veins (PV4Vaverage ), the fastest PV average (PVFVaverage ) and the fastest PVCL (PVfast ) both individually and relative to the average LAA cycle length (LAAaverage ), was calculated. CA included PVI and posterior wall isolation with a minimum 12-month follow up including regular Holter monitoring or device interrogation. Results: 100 patients underwent index CA (age 61 ± 8.5yrs; 49% hypertensive; average CHA2DS2-VASc = 1 ± 0.9; LVEF = 51 ± 12%; LA area 29 ± 7.2cm2 ; AF duration 14.6 ± 15.6 months). PVI was achieved in 100%. Single procedure success was achieved in 75% at 16.5 ± 7 months. There was no significant difference in absolute PVCL4Vaverage , PVCLFVaverage or PVCLfast or as ratio relative to average LAA CL or AF within a PV (Table 1) in patients with or without AF recurrence. Conclusion: Rapid PV firing was not a predictor of long term outcome following catheter ablation for PeAF.
332 Radiation Exposure During Atrial Fibrillation (AF) Ablation Utilising Cryoballoon Technology J. Hayes 1 , W. Stafford 1 , I. Smith 2 , H. Mattson 3 , A. Van Der Meer 4,∗ 1 Queensland Cardiovascular Group, Brisbane, Australia 2 St Andrew’s War Memorial Hospital, Brisbane, Australia 3 Medtronic, Minneapolis, USA 4 Medtronic, Sydney, Australia
Background: Recent advances in technology have had a significant impact on the electrophysiology-based treatment of atrial fibrillation (AF). Main areas of impact involve radiation risk and procedure time. We evaluate use of cryoablations compared to conventional radiofrequency (RF) ablation procedures. Methods: Details for 292 consecutive patients undergoing index AF ablation were captured into a single-centre registry. Radiation, procedural and outcome data for three ablation techniques were compared: RF ablation with (30) and without (59) the anti-scatter grid (RF Grid and RF Gridless) and cryoballoon ablation (203) utilising the first and second generation Medtronic Arctic Front Cryoballoons (Cryo). The dose area product (DAP; Gy cm2) was adjusted for a standardised patient weight of 80 kg. Results/Discussion: DAP was significantly higher for RF Grid (7.31) than the Cryo (2.09) and RF Gridless groups (3.11). DAP for Cryo was significantly lower than RF Gridless (p < 0.001). Similarly, fluoroscopy time (FT) was significantly different between Cryo and RF Gridless cohorts (13.1 vs. 16.8 min; p < 0.001) as were the procedure times (85 min vs. 146 min; p < 0.001), respectively. There was no significant difference in procedural outcome and complication rates between the three approaches. Conclusion: Cryoballoon technology offers a viable means of significantly improving the efficiency of index AF ablations. Significant reductions in radiation exposure and procedure time while maintaining safety and efficacy were achieved. http://dx.doi.org/10.1016/j.hlc.2017.06.333
S189
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333 Rapid Pulmonary Vein Firing Does Not Predict AF Ablation Outcome in Persistent AF S. Prabhu 1,∗ , M. Kalla 2 , A. Voskoboinik 1 , A. Mclellan 1 , K. Peck 1 , B. Pathik 2 , C. Nalliah 2 , G. Wong 2 , S. Azzopardi 1 , G. Lee 2 , J. Mariani 1 , L. Ling 1 , A. Taylor 1 , J. Kalman 2 , P. Kistler 1 1 Alfred
Health/Baker Heart and Diabetes Institute, Melbourne, Australia 2 Royal Melbourne Hospital, Melbourne, Australia Introduction: PVI remains the cornerstone of catheter ablation (CA) in persistent AF (PeAF) although less successful than for PAF. Rapid PV firing may identify PeAF patients more likely to benefit from a PV based approach. We sought to evaluate the relationship between PVCL and outcome following CA for PeAF. Methods: Prior to ablation for peAF, PV cycle length (PVCL) was recorded with a multipolar catheter in each PV and the left atrial appendage (LAA) for 100 consecutive cycles. For each patient, the average PVCL of all 4 veins (PV4Vaverage ), the fastest PV average (PVFVaverage ) and the fastest PVCL (PVfast ) both individually and relative to the average LAA cycle length (LAAaverage ), was calculated. CA included PVI and posterior wall isolation with a minimum 12-month follow up including regular Holter monitoring or device interrogation. Results: 100 patients underwent index CA (age 61 ± 8.5yrs; 49% hypertensive; average CHA2DS2-VASc = 1 ± 0.9; LVEF = 51 ± 12%; LA area 29 ± 7.2cm2 ; AF duration 14.6 ± 15.6 months). PVI was achieved in 100%. Single procedure success was achieved in 75% at 16.5 ± 7 months. There was no significant difference in absolute PVCL4Vaverage , PVCLFVaverage or PVCLfast or as ratio relative to average LAA CL or AF within a PV (Table 1) in patients with or without AF recurrence. Conclusion: Rapid PV firing was not a predictor of long term outcome following catheter ablation for PeAF.