Published online May 26, 2019. doi: 10.4330/wjc.v11.i5.149
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
The prevalence of atrial fibrillation (AF) is on the rise in the growing aging population with congenital heart disease (CHD). Although a few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF, cryoballoon ablation has not previously been studied in this patient population.
The theoretical advantages of cryoballoon ablation include its favorable safety profile and shorter procedural time, which could be valuable when targeting multiple arrhythmias during a single intervention, as is often the case in patients with CHD.
We sought to assess the feasibility, safety, and recurrence-free survival in our initial experience with cryoballoon ablation for AF in patients with CHD.
A single-center cohort study was conducted which enrolled consecutive patients with CHD and cryoballoon ablation for AF was carried out 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.
Ten patients with CHD and a median age of 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.
Cryoballoon ablation for AF is feasible and appears to have an acceptable safety profile in patients with CHD. In our initial experience, the acute success rate for PVI was high, with a modest 1-year event-free survival rate after a single procedure.
Further studies are required to provide mechanistic insights regarding triggers and substrates for AF in the various forms of CHD, and to compare cryoballoon ablation with radio-frequency catheter ablation.