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Does cryoballoon work with left common pulmonary veins?
Or does the fixed @Medtronic cryoballoon size compromise outcomes with these larger atypical ostial geometries, meaning we should use @BiosenseWebster CF-RF?
@msfhr @UBCmedicine @HeartandStroke https://onlinelibrary.wiley.com/doi/abs/10.1111/jce.14652">https://onlinelibrary.wiley.com/doi/abs/1...
Or does the fixed @Medtronic cryoballoon size compromise outcomes with these larger atypical ostial geometries, meaning we should use @BiosenseWebster CF-RF?
@msfhr @UBCmedicine @HeartandStroke https://onlinelibrary.wiley.com/doi/abs/10.1111/jce.14652">https://onlinelibrary.wiley.com/doi/abs/1...
Observational data from Shigata et al. And Kubala et al. have suggested that arrhythmia recurrence may be higher in patients with LCPV treated with cryoballoon ablation, when compared to those with standard PV anatomy
However, these studies lacked a key comparator group (ie RF ablation), and their observational nature meant the decision to employ cryoballoon ablation (or RF ablation) was subject to confounding
We thought it would be good to look at this in CIRCA-DOSE
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622">https://www.ahajournals.org/doi/10.11...
We thought it would be good to look at this in CIRCA-DOSE
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622">https://www.ahajournals.org/doi/10.11...
The CIRCA-DOSE study was designed to be reflective of clinical practice
As such we DID NOT exclude any patient on the basis of their PV anatomy
Following enrolment patients’ anatomy was assesssd and classified based on their PV drainage pattern
https://pubmed.ncbi.nlm.nih.gov/14739316/ ">https://pubmed.ncbi.nlm.nih.gov/14739316/...
As such we DID NOT exclude any patient on the basis of their PV anatomy
Following enrolment patients’ anatomy was assesssd and classified based on their PV drainage pattern
https://pubmed.ncbi.nlm.nih.gov/14739316/ ">https://pubmed.ncbi.nlm.nih.gov/14739316/...
A LCPV was identified in 47 patients (13.6%), which is consistent with what would be expected in an unselected population (eg 14% in the Marom paper from last tweet).
20 randomised to CF-RF and 27 to CB.
There were no significant differences in between groups.
20 randomised to CF-RF and 27 to CB.
There were no significant differences in between groups.
Recall in the main study that the cryoballoon procedures were significant shorter.
In this sub-study a LCPV did not negatively impact procedure or fluoroscopy time in the CB group.
But the CF-RF procedures were shorter in the presence of LCPV.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622">https://www.ahajournals.org/doi/10.11...
In this sub-study a LCPV did not negatively impact procedure or fluoroscopy time in the CB group.
But the CF-RF procedures were shorter in the presence of LCPV.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622">https://www.ahajournals.org/doi/10.11...
Post ablation the freedom from recurrent arrhythmia was worse for those with LCPV compared to those without LCPV (which looks quite similar to the Shigata/Kubala curves)
Although arrhythmia burden did not differ.
https://onlinelibrary.wiley.com/doi/abs/10.1111/jce.14652">https://onlinelibrary.wiley.com/doi/abs/1...
Although arrhythmia burden did not differ.
https://onlinelibrary.wiley.com/doi/abs/10.1111/jce.14652">https://onlinelibrary.wiley.com/doi/abs/1...
When examined by ablation technology, there was no difference in arrhythmia recurrence in those with normal PV branching patterns (which is expected given the results of the main study)
But...
Interetingly, there was no difference between CF-RF and Cryoballoon even in the presence of the LCPV.
Interetingly, there was no difference between CF-RF and Cryoballoon even in the presence of the LCPV.
The same lack of difference between CF-RF and Cryoballoon was observed in post ablation AF burden.
As such, we concluded that it’s the LCPV itself that drives the higher rate of arrhythmia recurrence, and not necessarily the ablation technology itself.
Both cryoballoon and CF-RF reduced AF burden post ablation with a similar rate of recurrence.
/fin
Both cryoballoon and CF-RF reduced AF burden post ablation with a similar rate of recurrence.
/fin
