Abadir S, Waldmann V, Dyrda K, Laredo M, Mondésert B, Dubuc M, Khairy P. Feasibility and safety of cryoballoon ablation for the treatment of atrial fibrillation in patients with congenital heart disease. World J Cardiol 2019; 11(5): 149-158 [PMID: 31171960 DOI: 10.4330/wjc.v11.i5.149]
Corresponding Author of This Article
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
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
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/
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
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
We sought to assess the feasibility, safety, and recurrence-free survival in our initial experience with cryoballoon ablation for AF in patients with CHD.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
