FUNDING The Effect of Cryoballoon and RF Ablation
FUNDING Ø The Effect of Cryoballoon and RF Ablation on LA Function (Cryo. LAEF) study (Clinical Τrials. gov Identifier: NCT 02611869) was partially supported as an External Research Protocol by a research grant from Medtronic Hellas.
INTRODUCTION Ø LAA functional modification in the context of PV isolation has been a focus point of research and LAA emptying flow velocity (LAAEFV) is considered to reflect LAA contractility, stunning and fibrosis Ø In the present study we sought to prospectively evaluate short-term LAAEFV changes after RF or cryoballoon ablation in PAF
METHODS Ø Prospective substudy of the Effect of Cryoballoon and RF Ablation on LA Function (Cryo. LAEF) study (Clinical. Trials. gov Identifier: NCT 02611869) Ø 30 pts, blindly and randomly assigned to RF or cryoablation, were prospectively followed Ø TOE were performed at baseline and at 3 months postablation to measure LAAEFV Ø All measurements were performed in SR
INCLUSION CRITERIA Ø At least 2 AF episodes within the last 2 months (self –terminating within 7 d or cardioverted in less than 48 h) Ø AF episodes should have been symptomatic Ø At least one episode under treatment with class I or III antiarrhythmic agent EXCLUSION CRITERIA Ø Previous LA ablation Ø LA > 50 mm Ø Atrial thrombus Ø Primary electrical disorders Ø Prosthetic valve at any position Ø Moderate/severe MS & Severe MR Ø Active infection/malignancy Ø Hepatic and Renal failure Ø Inability or unwillingness
RESULTS Ι Ø LAAFV Doppler measurements before Cryoballoon ablation Ø 3 months following Cryoballoon ablation
RESULTS ΙΙ 79. 9 73. 9 69. 2 76. 6 68 52. 5 37. 7 68. 5 61. 9 52. 9 42. 8 38. 7 OVERALL 44. 2 BASELINE TO 70. 8 cm/s
RESULTS ΙΙΙ 37. 0 29. 6 26. 2 15. 8 11 4. 7
DISCUSSION I Ø A handful of studies have prospectively evaluated LAAEF change after ablation for AF ü Fiala et al. ü Kusa et al. ü Yoshida et al. Ø All pts were evaluated under AF at baseline
DISCUSSION II Ø The first study to prospectively evaluate the effect of balloon cryoablation, along with RF, on LAAEFV in PAF with all pts in SR Ø Beneficial effect of ablation valid for pts with PAF under SR, even in a population with relatively “healthy” atria
STUDY LIMITATIONS Ø The small sample size of this substudy does not allow for observations involving clinical endpoints ü Mid/long-term AF recurrences ü thromboembolic complication rates Ø The study design did not include a medically managed group of pts that would serve as a comparator
CONCLUSION Ø LAA function is improved after ablation with RF or balloon cryoablation in pts with PAF in SR Ø Functional improvement is not just a matter of changing the rhythm from AF to SR, but rather an enduring result, which can be plausibly attributed to the lessening of AF burden Ø The present findings hint at a potential thromboprophylactic effect
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