Long-Term Results of Radiofrequency Hot Balloon Ablation in Patients With Paroxysmal Atrial Fibrillation: Safety and Rhythm Outcomes.
BACKGROUND
Isolation of pulmonary veins (PVs) and the posterior left atrium (LA) can be safely performed by radiofrequency hot balloon (RHB)-based box isolation. However, data on long-term effects for the treatment of atrial fibrillation (AF) by the use of this method remain limited.


RESULTS
We treated 238 patients with paroxysmal AF (194 male; age. 62.6 ± 9.4 years) by RHB ablation. During 6.2-year (75 months) follow-up, 154 (64.7%) patients were free from atrial tachyarrhythmias (ATAs) without antiarrhythmic-drugs (AADs). We performed re-ablation in 69 of 84 patients with ATA recurrence (average 1.3 ± 0.6; median 1, total 91 procedures) using a 3D-mapping system and a conventional catheter. The sites of reconnection were observed at the PV in 61 of 69 (88.4%) patients and at the posterior LA in 58 of 69 (84.1%) patients. Finally, during mean follow-up of 4.6 ± 1.6 years, no-ATA episodes were detected in 201 (84.5%) patients without AADs. Independent predictors of ATA recurrence following a single procedure were heart failure with preserved ejection fraction (HR: 2.67, 95%CI: 1.40-5.10, P = 0.003) and low estimated glomerular filtration rate (HR: 1.81, 95%CI: 1.11-2.93, P = 0.03; cut-off of 62.0 mL/min/1.73 m(2)). During the follow-up period, there were 4 (1.7%) patients with PV stenosis (>70% reduction in PV diameter); however, none of these cases required intervention. Phrenic nerve palsy was detected in 8 patients (3.4%), but resolved during 3 months in all cases.


CONCLUSIONS
RHB ablation can be effective during a long-term follow-up for patients with paroxysmal AF. Safety outcomes were within an acceptable range.
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Yoshio
Y
Yamaguchi
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Hiroshi
H
Sohara
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Hiroshi
H
Takeda
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Yoshinori
Y
Nakamura
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Minoru
M
Ihara
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Satoshi
S
Higuchi
Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan.
Shutaro
S
Satake
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve; D011666:Pulmonary Valve Stenosis / Q000209:etiology; D012008:Recurrence; D013318:Stroke Volume; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
atrial fibrillation; catheter ablation; hot balloon ablation; phrenic nerve injury; pulmonary vein isolation