What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring

Christian Hendrik Heeger; Verena Tscholl; Omar Salloum; Erik Wissner; Thomas Fink; Laura Rottner; Peter Wohlmuth; Barbara Bellmann; Mattias Roser; Shibu Mathew; Bruno Reißmann; Christine Lemeš; Tilman Maurer; Francesco Santoro; Britta Goldmann; Ulf Landmesser; Feifan Ouyang; Karl Heinz Kuck; Andreas Rillig; Andreas Metzner

doi:10.1016/j.hrthm.2018.07.016

What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring

Christian Hendrik Heeger^*, Verena Tscholl, Omar Salloum, Erik Wissner, Thomas Fink, Laura Rottner, Peter Wohlmuth, Barbara Bellmann, Mattias Roser, Shibu Mathew, Bruno Reißmann, Christine Lemeš, Tilman Maurer, Francesco Santoro, Britta Goldmann, Ulf Landmesser, Feifan Ouyang, Karl Heinz Kuck, Andreas Rillig, Andreas Metzner

^*Korrespondierende/r Autor/-in für diese Arbeit

12 Zitate (Scopus)

Abstract

Background: Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results for the treatment of paroxysmal atrial fibrillation (AF) and persistent AF. However, rhythm follow-up after PVI is mainly based on Holter electrocardiography of limited duration. Objective: The purpose of this study was to assess the real AF burden following CB2-based PVI in patients with implanted cardiac devices. Methods: A total of 670 consecutive patients underwent CB2-based PVI at 3 electrophysiology centers. In 66 patients (9.9%), an implantable cardiac device with continuous monitor function was independently implanted before the procedure (device group). This patient cohort was compared to propensity score-matched patients without cardiac devices (n = 66; control group). Results: A total of 254 of 258 PVs (98.4%0 in the device group were successfully isolated using only CB2. Postprocedural device interrogation found no device or lead malfunction related to the procedure. Periprocedural complications were registered in 7 of 66 patients (11%) in the device group and in 6 of 66 patients (9%) in the control group (P =.770). Phrenic nerve palsy occurred in 6 of 66 patients (9%) in the device group) and in 2 of 66 patients (3%) in the control group) (P =.274). Clinical success in terms of freedom from AF recurrence after a 1-year follow-up period was 63.8% (95% confidence interval 53–77) in the device group and 77.3% (95% confidence interval 68–88) in the control group (P =.038). In the device group, AF/AT burden decreased from 41.8% ± 35.0% before the procedure to 10.2% ± 22.4% after 1 year (P <.0001). Conclusion: CB2-PVI seems safe and feasible in patients with an implanted cardiac device. A significantly higher AF/AT burden was seen in patients with an implanted cardiac device compared to a control group.

Originalsprache	Englisch
Zeitschrift	Heart Rhythm
Jahrgang	15
Ausgabenummer	12
Seiten (von - bis)	1844-1850
Seitenumfang	7
ISSN	1547-5271
DOIs	https://doi.org/10.1016/j.hrthm.2018.07.016
Publikationsstatus	Veröffentlicht - 12.2018

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10.1016/j.hrthm.2018.07.016

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Heeger, C. H., Tscholl, V., Salloum, O., Wissner, E., Fink, T., Rottner, L., Wohlmuth, P., Bellmann, B., Roser, M., Mathew, S., Reißmann, B., Lemeš, C., Maurer, T., Santoro, F., Goldmann, B., Landmesser, U., Ouyang, F., Kuck, K. H., Rillig, A., & Metzner, A. (2018). What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring. Heart Rhythm, 15(12), 1844-1850. https://doi.org/10.1016/j.hrthm.2018.07.016

@article{6ae56668e2284d52a9aec5fc48395b24,

title = "What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring",

abstract = "Background: Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results for the treatment of paroxysmal atrial fibrillation (AF) and persistent AF. However, rhythm follow-up after PVI is mainly based on Holter electrocardiography of limited duration. Objective: The purpose of this study was to assess the real AF burden following CB2-based PVI in patients with implanted cardiac devices. Methods: A total of 670 consecutive patients underwent CB2-based PVI at 3 electrophysiology centers. In 66 patients (9.9%), an implantable cardiac device with continuous monitor function was independently implanted before the procedure (device group). This patient cohort was compared to propensity score-matched patients without cardiac devices (n = 66; control group). Results: A total of 254 of 258 PVs (98.4%0 in the device group were successfully isolated using only CB2. Postprocedural device interrogation found no device or lead malfunction related to the procedure. Periprocedural complications were registered in 7 of 66 patients (11%) in the device group and in 6 of 66 patients (9%) in the control group (P =.770). Phrenic nerve palsy occurred in 6 of 66 patients (9%) in the device group) and in 2 of 66 patients (3%) in the control group) (P =.274). Clinical success in terms of freedom from AF recurrence after a 1-year follow-up period was 63.8% (95% confidence interval 53–77) in the device group and 77.3% (95% confidence interval 68–88) in the control group (P =.038). In the device group, AF/AT burden decreased from 41.8% ± 35.0% before the procedure to 10.2% ± 22.4% after 1 year (P <.0001). Conclusion: CB2-PVI seems safe and feasible in patients with an implanted cardiac device. A significantly higher AF/AT burden was seen in patients with an implanted cardiac device compared to a control group.",

author = "Heeger, {Christian Hendrik} and Verena Tscholl and Omar Salloum and Erik Wissner and Thomas Fink and Laura Rottner and Peter Wohlmuth and Barbara Bellmann and Mattias Roser and Shibu Mathew and Bruno Rei{\ss}mann and Christine Leme{\v s} and Tilman Maurer and Francesco Santoro and Britta Goldmann and Ulf Landmesser and Feifan Ouyang and Kuck, {Karl Heinz} and Andreas Rillig and Andreas Metzner",

year = "2018",

month = dec,

doi = "10.1016/j.hrthm.2018.07.016",

language = "English",

volume = "15",

pages = "1844--1850",

journal = "Heart Rhythm",

issn = "1547-5271",

number = "12",

}

Heeger, CH, Tscholl, V, Salloum, O, Wissner, E, Fink, T, Rottner, L, Wohlmuth, P, Bellmann, B, Roser, M, Mathew, S, Reißmann, B, Lemeš, C, Maurer, T, Santoro, F, Goldmann, B, Landmesser, U, Ouyang, F, Kuck, KH, Rillig, A & Metzner, A 2018, 'What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring', Heart Rhythm, Jg. 15, Nr. 12, S. 1844-1850. https://doi.org/10.1016/j.hrthm.2018.07.016

What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring. / Heeger, Christian Hendrik; Tscholl, Verena; Salloum, Omar et al.
in: Heart Rhythm, Jahrgang 15, Nr. 12, 12.2018, S. 1844-1850.

Publikation: Beiträge in Fachzeitschriften › Zeitschriftenaufsätze › Forschung › Begutachtung

TY - JOUR

T1 - What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring

AU - Heeger, Christian Hendrik

AU - Tscholl, Verena

AU - Salloum, Omar

AU - Wissner, Erik

AU - Fink, Thomas

AU - Rottner, Laura

AU - Wohlmuth, Peter

AU - Bellmann, Barbara

AU - Roser, Mattias

AU - Mathew, Shibu

AU - Reißmann, Bruno

AU - Lemeš, Christine

AU - Maurer, Tilman

AU - Santoro, Francesco

AU - Goldmann, Britta

AU - Landmesser, Ulf

AU - Ouyang, Feifan

AU - Kuck, Karl Heinz

AU - Rillig, Andreas

AU - Metzner, Andreas

PY - 2018/12

Y1 - 2018/12

N2 - Background: Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results for the treatment of paroxysmal atrial fibrillation (AF) and persistent AF. However, rhythm follow-up after PVI is mainly based on Holter electrocardiography of limited duration. Objective: The purpose of this study was to assess the real AF burden following CB2-based PVI in patients with implanted cardiac devices. Methods: A total of 670 consecutive patients underwent CB2-based PVI at 3 electrophysiology centers. In 66 patients (9.9%), an implantable cardiac device with continuous monitor function was independently implanted before the procedure (device group). This patient cohort was compared to propensity score-matched patients without cardiac devices (n = 66; control group). Results: A total of 254 of 258 PVs (98.4%0 in the device group were successfully isolated using only CB2. Postprocedural device interrogation found no device or lead malfunction related to the procedure. Periprocedural complications were registered in 7 of 66 patients (11%) in the device group and in 6 of 66 patients (9%) in the control group (P =.770). Phrenic nerve palsy occurred in 6 of 66 patients (9%) in the device group) and in 2 of 66 patients (3%) in the control group) (P =.274). Clinical success in terms of freedom from AF recurrence after a 1-year follow-up period was 63.8% (95% confidence interval 53–77) in the device group and 77.3% (95% confidence interval 68–88) in the control group (P =.038). In the device group, AF/AT burden decreased from 41.8% ± 35.0% before the procedure to 10.2% ± 22.4% after 1 year (P <.0001). Conclusion: CB2-PVI seems safe and feasible in patients with an implanted cardiac device. A significantly higher AF/AT burden was seen in patients with an implanted cardiac device compared to a control group.

AB - Background: Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results for the treatment of paroxysmal atrial fibrillation (AF) and persistent AF. However, rhythm follow-up after PVI is mainly based on Holter electrocardiography of limited duration. Objective: The purpose of this study was to assess the real AF burden following CB2-based PVI in patients with implanted cardiac devices. Methods: A total of 670 consecutive patients underwent CB2-based PVI at 3 electrophysiology centers. In 66 patients (9.9%), an implantable cardiac device with continuous monitor function was independently implanted before the procedure (device group). This patient cohort was compared to propensity score-matched patients without cardiac devices (n = 66; control group). Results: A total of 254 of 258 PVs (98.4%0 in the device group were successfully isolated using only CB2. Postprocedural device interrogation found no device or lead malfunction related to the procedure. Periprocedural complications were registered in 7 of 66 patients (11%) in the device group and in 6 of 66 patients (9%) in the control group (P =.770). Phrenic nerve palsy occurred in 6 of 66 patients (9%) in the device group) and in 2 of 66 patients (3%) in the control group) (P =.274). Clinical success in terms of freedom from AF recurrence after a 1-year follow-up period was 63.8% (95% confidence interval 53–77) in the device group and 77.3% (95% confidence interval 68–88) in the control group (P =.038). In the device group, AF/AT burden decreased from 41.8% ± 35.0% before the procedure to 10.2% ± 22.4% after 1 year (P <.0001). Conclusion: CB2-PVI seems safe and feasible in patients with an implanted cardiac device. A significantly higher AF/AT burden was seen in patients with an implanted cardiac device compared to a control group.

UR - http://www.scopus.com/inward/record.url?scp=85056455328&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2018.07.016

DO - 10.1016/j.hrthm.2018.07.016

M3 - Journal articles

C2 - 30010056

AN - SCOPUS:85056455328

SN - 1547-5271

VL - 15

SP - 1844

EP - 1850

JO - Heart Rhythm

JF - Heart Rhythm

IS - 12

ER -