Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2019; 11(5): 149-158
Published online May 26, 2019. doi: 10.4330/wjc.v11.i5.149
Feasibility and safety of cryoballoon ablation for the treatment of atrial fibrillation in patients with congenital heart disease
Sylvia Abadir, Victor Waldmann, Katia Dyrda, Mikael Laredo, Blandine Mondésert, Marc Dubuc, Paul Khairy
Sylvia Abadir, Victor Waldmann, Katia Dyrda, Mikael Laredo, Blandine Mondésert, Marc Dubuc, Paul Khairy, Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal QC H1T 1C8, Canada
Author contributions: Abadir S and Waldmann V contributed equally as co-first authors; Abadir S, Waldmann V and Khairy P contributed to concept/design, drafting the article, statistics, data collection, data analysis and interpretation; Dyrda K, Laredo M, Mondésert B and Dubuc M critically revised the article; Abadir S, Waldmann V, Dyrda K, Laredo M, Mondésert B, Dubuc M and Khairy P approved the article; Khairy P contributed to funding.
Institutional review board statement: The study was approved by the local institutional review board.
Conflict-of-interest statement: Dr. Dubuc is a consultant for Medtronic CryoCath LP. The authors have no other relevant conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Paul Khairy, FRCPC, MD, PhD, Full Professor, Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger St E, Montreal QC H1T 1C8, Canada. paul.khairy@umontreal.ca
Telephone: +1-514-3763330-3800 Fax: +1-514-5932581
Received: February 3, 2019
Peer-review started: February 11, 2019
First decision: April 16, 2019
Revised: April 19, 2019
Accepted: May 14, 2019
Article in press: May 14, 2019
Published online: May 26, 2019
Processing time: 112 Days and 17.6 Hours
Abstract
BACKGROUND

The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PVs) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time.

AIM

To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD.

METHODS

The study population consisted of consecutive patients with CHD who underwent cryoballoon ablation for AF at the Montreal Heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the PV. At least one 240-s cryothermal application was performed when complete PV occlusion was obtained. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and annually thereafter.

RESULTS

Ten patients with a median age of 57.9 (interquartile range 48.2-61.7 years) and 60% female, met the inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) years. Two patients had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return; aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The PV anatomy was normal in 6 (60.0%) patients. Four had left common PV (n = 3) and/or 3 right PV (n = 2). Electrical pulmonary vein isolation (PVI) was acutely successful in all patients. One patient had transient phrenic nerve palsy that recovered during the intervention. No major complications occurred. One year after a single ablation procedure, 6 (60%) patients remained AF-free. One patient with recurrent AF had recovered PV conduction and underwent a second PVI procedure. A second patient underwent ablation of an extra-pulmonary vein trigger for AF.

CONCLUSION

Cryoballoon ablation for AF is feasible and safe in patients with simple and moderate forms of CHD, with an excellent acute success rate and modest 1-year freedom from recurrent AF.

Keywords: Congenital heart disease; Atrial fibrillation; Cryoballoon ablation; Pulmonary vein isolation; Catheter ablation

Core tip: A few studies have described radiofrequency ablation for atrial fibrillation (AF) in patients with congenital heart disease (CHD). Herein, we report the first case series of cryoballoon ablation for the treatment of AF in patients with CHD. Ten patients with CHD, median age 57.9 years, underwent cryoballoon ablation and were followed for a median of 2.8 years. Pulmonary vein isolation was acutely successful in all patients. No major complications occurred. One year after a single procedure, 6 (60%) patients remained AF-free. In conclusion, cryoballoon ablation is feasible and appears to be safe, with an excellent acute success rate and modest 1-year freedom from recurrent AF.