Réintervention(s) en radiofréquence après cryoablation de fibrillation atriale persistante : résultats à 20 mois

Abstract : Aim : the ablation strategy in the treatment of persistent atrial fibrillation (AF) is still an ongoing debate. A pulmonary vein isolation must be performed. Ablation targeting others substrate in the left atria (LA) doesn’t show superiority and is indicated in IIb class. We reported results of cryoablation as a first procedure, followed by radiofrequency linear ablation in case of an arythmia recurrence. Methods : forty-four patients with recurrence of persistent AF following a second-generation cryoballoon pulmonary vein isolation underwent at least one repeat ablation in radiofrequency, with creation of a mitral isthmus line and a LA roof line, between march 2013 and april 2018. Our prospective follow-up evaluated the freedom from AF and the predictors of arythmia recurrence. Results : thirty-one patients (70.5%) were in sinus rythm after a mean of 1.3 ± 0.6 radiofrequency procedures, with a follow-up of 20.6 ± 13.4 months since the first repeat ablation and 17 ± 13 months since the last procedure. On univariate analysis, LA size was a predictor of relapse, for an area at or beyond 30 cm² (HR 4.712, IC 1.357-16.362, p=0.015) and a volume at or beyond 200 mL (HR 3.279, IC 1.057-10.174, p=0.04). We had only one serious complication, a cardiac tamponade. Conclusion : our strategy of repeated ablation(s) with creation of LA lines in radiofrequency after persistent AF recurrence following an index procedure of cryoballoon pulmonary vein isolation, apparead safe and effective, with 70.5% of freedom from any atrial arythmia at 20 months follow-up.
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Floriane Fay. Réintervention(s) en radiofréquence après cryoablation de fibrillation atriale persistante : résultats à 20 mois. Cardiologie et système cardiovasculaire. 2018. ⟨dumas-02083150⟩

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