ISSN 1671-5411 CN 11-5329/R
Volume 17 Issue 8
Sep.  2020
Turn off MathJax
Article Contents
Zhong-Jing CAO, Xiao-Gang GUO, Qi SUN, Jian-Du YANG, Hui-Qiang WEI, Shu ZHANG, Jian MA. Pulmonary vein isolation implemented by second-generation cryoballoon for treating hypertrophic cardiomyopathy patients with symptomatic atrial fibrillation: a case-control study. J Geriatr Cardiol 2020; 17(8): 476-485. doi: 10.11909/j.issn.1671-5411.2020.08.011
Citation: Zhong-Jing CAO, Xiao-Gang GUO, Qi SUN, Jian-Du YANG, Hui-Qiang WEI, Shu ZHANG, Jian MA. Pulmonary vein isolation implemented by second-generation cryoballoon for treating hypertrophic cardiomyopathy patients with symptomatic atrial fibrillation: a case-control study. J Geriatr Cardiol 2020; 17(8): 476-485. doi: 10.11909/j.issn.1671-5411.2020.08.011

Pulmonary vein isolation implemented by second-generation cryoballoon for treating hypertrophic cardiomyopathy patients with symptomatic atrial fibrillation: a case-control study

doi: 10.11909/j.issn.1671-5411.2020.08.011
More Information
  • Corresponding author: Jian MA, MD, Arrhythmia Center, State Key Labo ratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Pe king Union Medical College, Beijing, China. E-mail:
  • Received Date: 2020-07-03
  • Accepted Date: 2020-08-14
  • Rev Recd Date: 2020-07-30
  • Available Online: 2020-08-28
  • Publish Date: 2020-09-07
  •  Background Atrial fibrillation (AF) is a generally acknowledged turning-point of the natural history of hypertrophic cardiomyopathy (HCM); however, data from the cryoballoon ablation (CBA) for AF in HCM patients are relatively scarce. The study aimed to evaluate the efficacy and safety of CBA in HCM patients with AF. Methods We retrospectively analyzed HCM patients among 1253 patients with symptomatic AF who underwent CBA for pulmonary vein isolation in a single center. The study analyzed the AF recurrence and assessed the CBA indexes, including nadir temperature, time-to-isolation, CBA failure, pulmonary vein potentials (PVPs), and redo procedure. Results A total of 108 patients were included (mean age: 59.0 ± 6.9 years), 27 patients (25%) had HCM, with the median follow-up duration of 25.5 months. The one-year AF-free rates were 79.0% vs. 63.0% (non-HCM vs. HCM), while the two-year AF-free rates were 77.8% vs. 55.1% [hazard ratio (HR) = 2.758, log-rank P = 0.024]. Patients with persistent AF had poor AF-free rates compared to those with paroxysmal AF (P < 0.001). The CBA failure was the most common in the right inferior pulmonary veins, which had the lowest PVPs. Multivariate Cox regression analysis indicated that HCM and persistent AF were risk factors for AF recurrence (HR = 2.74, 95% CI: 1.29–5.79, P = 0.008; and HR = 3.97, 95% CI: 1.85–8.54, P < 0.001, respectively). Conclusions The CBA can be effectively and safely used to treat HCM patients with symptomatic AF. The freedom from AF for HCM patients after CBA is relatively low compared to that for non-HCM patients.
  • loading
  • [1]
    Rowin EJ, Hausvater A, Link MS, et al. Clinical profile and consequences of atrial fibrillation in hypertrophic cardio myopathy. Circulation 2017; 136: 2420-2436. doi: 10.1161/CIRCULATIONAHA.117.029267
    Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet 2013; 381: 242-255. doi: 10.1016/S0140-6736(12)60397-3
    Maron BJ, Olivotto I, Bellone P, et al. Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 39: 301-307.
    Zhao DS, Shen Y, Zhang Q, et al. Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardio myopathy: a systematic review and meta-analysis. Euro pace 2016; 18: 508-520.
    Providencia R, Elliott P, Patel K, et al. Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systema tic review and meta-analysis. Heart 2016; 102: 1533-1543. doi: 10.1136/heartjnl-2016-309406
    Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med 2016; 374: 2235-2245. doi: 10.1056/NEJMoa1602014
    Hoffmann E, Straube F, Wegscheider K, et al. Outcomes of cryoballoon or radiofrequency ablation in symptomatic paro xysmal or persistent atrial fibrillation. Europace 2019; 21: 1313-1324. doi: 10.1093/europace/euz155
    Mörtsell D, Arbelo E, Dagres N, et al. Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry. Europace 2019; 21: 581-589. doi: 10.1093/europace/euy239
    Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and mana gement of hypertrophic cardiomyopathy of the European So ciety of Cardiology (ESC). Eur Heart J 2014; 35: 2733-2779. doi: 10.1093/eurheartj/ehu284
    Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14: e275-e444. doi: 10.1016/j.hrthm.2017.05.012
    January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fib rillation: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guide lines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64: e1-e76. doi: 10.1016/j.jacc.2014.03.022
    Maagh P, Plehn G, Christoph A, et al. Impact of cryoballoon ablation in hypertrophic cardiomyopathy-related heart failure due to paroxysmal atrial fibrillation. A comparative case series. Int J Med Sci 2016; 13: 664-672. doi: 10.7150/ijms.16181
    Liu X, Ouyang F, Mavrakis H, et al. Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy. Euro pace 2005; 7: 421-427.
    Bassiouny M, Lindsay BD, Lever H, et al. Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy. Heart Rhythm 2015; 12: 1438-1447. doi: 10.1016/j.hrthm.2015.03.042
    Knight BP, Novak PG, Sangrigoli R, et al. Long-term out comes after ablation for paroxysmal atrial fibrillation using the second-generation cryoballoon: final results from STOP AF Post-Approval Study. JACC Clin Electrophysiol 2019; 5: 306-314. doi: 10.1016/j.jacep.2018.11.006
    Omran H, Gutleben KJ, Molatta S, et al. Second generation cryoballoon ablation for persistent atrial fibrillation: an updated meta-analysis. Clin Res Cardiol 2018; 107: 182-192. doi: 10.1007/s00392-017-1171-5
    Boveda S, Metzner A, Nguyen DQ, et al. Single-procedure outcomes and quality-of-life improvement 12 months post- cryo balloon ablation in persistent atrial fibrillation: results from the Multicenter CRYO4PERSISTENT AF Trial. JACC Clin Electrophysiol 2018; 4: 1440-1447. doi: 10.1016/j.jacep.2018.07.007
    Maron BJ, Spirito P, Green KJ, et al. Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echo car diography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1987; 10: 733-742. doi: 10.1016/S0735-1097(87)80264-4
    Robinson K, Frenneaux MP, Stockins B, et al. Atrial fib rillation in hypertrophic cardiomyopathy: a longitudinal study. J Am Coll Cardiol 1990; 15: 1279-1285. doi: 10.1016/S0735-1097(10)80014-2
    Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in colla boration with EACTS. Europace 2016; 18: 1609-1678. doi: 10.1093/europace/euw295
    Koektuerk B, Yorgun H, Hengeoez O, et al. Cryoballoon ablation for pulmonary vein isolation in patients with per sistent atrial fibrillation: one-year outcome using second generation cryoballoon. Circ Arrhythm Electrophysiol 2015; 8: 1073-1079. doi: 10.1161/CIRCEP.115.002776
    Nakagawa H, Scherlag BJ, Patterson E, et al. Pathophy siologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation. Heart Rhythm 2009; 6: S26-S34. doi: 10.1016/j.hrthm.2009.07.029
    Zhou GB, Guo XG, Liu XU, et al. Pulmonary vein isolation using the first-generation cryoballoon technique in Chinese patients. Pacing Clin Electrophysiol 2015; 38: 1073-1081. doi: 10.1111/pace.12675
    Ho SY, Cabrera JA, Tran VH, et al. Architecture of the pul monary veins: relevance to radiofrequency ablation. Heart 2001; 86: 265-270. doi: 10.1136/heart.86.3.265
    Saito T, Waki K, Becker AE. Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations re levant for atrial arrhythmias. J Cardiovasc Electrophysiol 2000; 11: 888-894. doi: 10.1111/j.1540-8167.2000.tb00068.x
    Matsumoto Y, Muraoka Y, Funama Y, et al. Analysis of the anatomical features of pulmonary veins on pre-procedural cardiac CT images resulting in incomplete cryoballoon ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2019; 13: 118-127. doi: 10.1016/j.jcct.2018.11.005
    Yokokawa M, Chugh A, Latchamsetty R, et al. Cryoballoon antral pulmonary vein isolation vs contact force-sensing radiofrequency catheter ablation for pulmonary vein and posterior left atrial isolation in patients with persistent atrial fibrillation. Heart Rhythm 2018; 15: 1835-1841. doi: 10.1016/j.hrthm.2018.06.047
    Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace 2018; 20: 33-42. doi: 10.1093/europace/eux013
    Zheng S, Jiang W, Dai J, et al. Five-year outcomes after catheter ablation for atrial fibrillation in patients with hyper trophic cardiomyopathy. J Cardiovasc Electrophysiol 2020; 31: 621-628. doi: 10.1111/jce.14349
    Aryana A, Singh SM, Mugnai G, et al. Pulmonary vein re connection following catheter ablation of atrial fibrillation using the second-generation cryoballoon versus open-irrigated radiofrequency: results of a multicenter analysis. J Interv Card Electrophysiol 2016; 47: 341-348. doi: 10.1007/s10840-016-0172-z
  • 加载中


    通讯作者: 陈斌,
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(3)

    Article Metrics

    Article views (244) PDF downloads(9) Cited by()
    Proportional views


    DownLoad:  Full-Size Img  PowerPoint