Cryoballoon left atrial roof ablation for persistent atrial fibrillation—Analysis with high‐resolution mapping system
Shinsuke Miyazaki, Kanae Hasegawa, Moe Mukai, Daisetsu Aoyama, Minoru Nodera, Hiroyasu Uzui, Hiroshi Tada
Abstract
Abstract Background Additional benefit of cryoballoon left atrial roof line ablation (CB‐RA) beyond cryoballoon pulmonary vein isolation (CB‐PVI) is suggested in patients with persistent atrial fibrillation (PsAF). We sought to investigate the feasibility of CB‐RA for PsAF and to determine the ablation area. Methods and Results Fifty‐three PsAF patients (67[58.5–75.5] years, 36 men, 11 longstanding PsAF) underwent CB‐PVI. Subsequently, 44(83.0%) out of 53 patients underwent additional CB‐RA. Voltage maps were created in all patients with a high‐resolution mapping system. The total number and duration of CB‐RAs were 3.9 ± 0.7 and 468 ± 84 s. LA roof areas were complete low voltage areas (LVAs) /scar in 37/44(84.1%) patients (“complete roof modification”). The normal LA posterior wall (LAPW) voltage area was 6.1(4.1–8.4) cm 2 , and the %LAPW isolation area was 61.0(47.2–71.7)%. The %LAPW isolation area was significantly greater in CB‐RA patients than those without (64.0[54.2–73.2] vs. 45.0[39.5–50.5]%, p = .041) despite significantly larger LAs in the former group. The %LAPW isolation area was significantly greater in patients with transverse LA diameters < 45 mm than those ≥ 45 mm ( p < .0001). The single procedure 1‐year AF freedom was 87.4% (22.5% on antiarrhythmic drug) and tended to be higher in CB‐RA patients than those without. Among the 44 CB‐RA patients, it was significantly higher in patients with a complete roof modification than those without (94.4% vs. 75.0%, p = .0049). One CB‐RA patient experienced a delayed cardiac tamponade requiring drainage at 4‐months post‐procedure. Conclusions CB‐RA significantly expanded the LAPW isolation area, and a complete roof modification resulted in a high arrhythmia freedom in PsAF patients.