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Cryoablation of letf atrium in atrial fibrillation, long-term efficacy and safety

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Langue d'expression : français, anglais
Date de parution :  2016

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Atrial fibrillation (AF) is common and associated with significant morbidity, mortality and important costs. Moderate efficacy and side effects of antiarhythmics drugs led to the development of ablation techniques aiming directly left atrium’s underlying substrate. Efficacy of cryoablation of pulmonary veins in patients with AF was several times studied but its outcomes in the long term are unknown. We evaluated in a cohort of patients, efficacy and safety of cryoablation of pulmonary veins in AF at 5 years.We collected medical data from any adult patient who underwent AF cryoablation between July 2007 and July 2015 in the Hôpital Louis Pradel, from patients’ hospital files. Every patient was reached by survey or by phone to collect the outcomes. Cryoablation efficacy was defined as AF recurrence-free survival and cryoablation safety defined by overall survival without any adverse events (thromboembolic events, death), nor procedures complications.Two hundred and forty-five patients were eligible and 221 were reached and included. Among them, 103 presented with atrial fibrillation recurrence. There was a 52,4 +/- 4,2% probability of sinus rhythm maintenance at 5 years. No predictive factor of recurrence was identified. Larger Body Mass Index and incomplete pulmonary veins isolation tended to be predictive of AF recurrence. Regarding safety, 8 patients suffered from stroke and 5 died. Probability of stroke at 5 years was 3,5 +/- 1,3% and probability of death at five years was 3,5 +/- 1,7%. Procedural complications were observed in 17,6% of the patients.Cryoablation of pulmonary veins allows in the long-term maintenance of sinus rhythm in half of the patients treated. An aggressive correction of risk factors of occurrence and progression of atrial myopathy, possible arrhythmogenic AF substrate, is necessary to complement cryoablation to decrease AF recurrences


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