Petter Janse

One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation

Aims Pulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences. Methods and results Patients with symptomatic AF despite anti-arrhythmic drugs (AADs) were treated with cryoballoon PVI. Daily transtelephonic ECG monitoring, 24 h Holter-ECG, and an arrhythmia-focused questionnaire were used to document AF. One hundred and forty-one patients completed a follow-up of 457 ± 252 days. Before ablation, Holter-ECG showed AF in 45%, including 16% continuous AF throughout the recording. Event recording revealed a median AF burden of 26%. The questionnaire showed a median of weekly AF complaints lasting for hours. All but one patient had successful PVI with a single procedure. After ablation, AF (defined as lasting for more than 30 s) was seen in 11% of Holter-ECGs, with 1% continuous AF. The event recording showed an AF burden of 9%. The median patient reported no more AF-related symptoms. Recurrence during the first 3 months was predictive for later recurrence. A second procedure was performed in 24 patients. The freedom of AF was 59% without AADs after 1,2 procedures. Four right phrenic nerve paralyses occurred, all resolving within 6 months. No PV stenoses were observed. Conclusion Pulmonary vein isolation with a cryothermal balloon is an effective treatment for paroxysmal AF, resulting in a clinical success rate comparable to studies involving radiofrequency ablation. Temporary right phrenic nerve paralysis is the most important complication.

Prognostic Role of High-Sensitivity C-Reactive Protein and B-Type Natriuretic Peptide in Implantable Cardioverter-Defibrillator Patients

Background: High‐sensitivity C‐reactive protein (hs‐CRP) and B‐type natriuretic peptide (BNP) are useful biomarkers for cardiovascular risk stratification. Little data are available regarding the prognostic value of hs‐CRP and BNP serum levels and future ventricular arrhythmic events triggering implantable cardioverter defibrillator (ICD) therapy.

Symptoms versus objective rhythm monitoring in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation

Background: Pulmonary vein (PV) ablation is a treatment option for patients with atrial fibrillation (AF). The efficacy of treatment is often assessed by the evaluation of symptoms. However, a high proportion of AF episodes occur in the absence of symptoms as observed in pharmacological treated patients. The purpose of this study was to assess the association of symptoms and AF in patients who underwent PV ablation for the treatment of paroxysmal AF. Methods: All consecutive patients scheduled for PV ablation received an event recorder 1 month prior to the ablation for the period of 4 months. Event strips were sent by telephone on a daily basis, and in case the patient suffered palpitations or other symptoms believed to be related to the arrhythmia. Results: Forty-one patients (7 females; mean age 52 years (range 24 to 71 years)) sent a total of 3046 event strips (735 before ablation; 2311 after ablation). Before ablation, a total amount of 244 event strips were obtained of which were 85 (35%) were asymptomatic. After ablation, a total amount of 254 AF event strips were obtained of which 164 were asymptomatic (65%). Correlation between symptoms and rhythm was often absent during AF. Conclusion: Our data demonstrate that for the evaluation of effectiveness of PV ablation, the lack of symptoms during follow-up is not a valid indication. Objective rhythm monitoring in order to detect asymptomatic AF should be performed.

Flutter ablation with remote magnetic navigation: comparison between the 8-mm tip, the irrigated tip and a manual approach.

INTRODUCTION Remote magnetic navigated ablation has proven its feasibility in a large group of arrhythmias. Until now only scarce data are available on the use for atrial flutter. In this study we compared remote magnetic navigation (RMN), using non-irrigated and irrigated tip catheters, to manual radiofrequency ablation for ablating typical atrial flutter. METHODS The 3 study groups consisted of 17 patients treated with RMN 8-mm tip; 14 patients with RMN irrigated tip; and 24 patients with a manual 8-mm tip. The primary outcome was the number of patients in whom bidirectional isthmus block could be obtained with < or = 15 applications. Secondary end points were the median number of applications needed, the need to switch to a manual irrigated tip catheter, the procedural and fluoroscopy times. RESULTS There was no significant difference in the primary end point (RMN 8 mm-tip group: 59%, RMN irrigated tip group: 64% and manual group: 83%). The median number of applications needed to obtain block was higher in the RMN groups compared to the manual group. In 5 patients from the RMN 8-mm tip group, 1 in the RMN irrigated tip group and 1 in the manual group, a switch to a manually irrigated tip catheter was performed.There was no difference in fluoroscopy time, but procedural time was significantly longer in the RMN groups compared to the manual group (P= 0.03). CONCLUSIONS The use of magnetic navigation for the ablation of atrial flutter is feasible but not superior to a manual approach. There was no difference concerning the primary end point of acute success within 15 applications. Overall, more applications were needed and procedure times were longer with RMN but RMN with the irrigating tip is promising.

Migraine accompagnée after transseptal puncture

Migraine has never been reported as a complication of transseptal puncture for ablation of atrial fibrillation. We studied its incidence before and after such procedures after observing some striking new migraine in several patients. A total of 8% of procedures for pulmonary vein isolation with a 15 Fr sheath used for transseptal puncture were associated with new headache with ocular symptoms or migraine within three months. Exacerbation of pre-existing migraine was reported in another 7% of procedures. More complaints were seen in redo procedures. The questionnaires were performed at three months after the intervention and there was no more evidence of persisting flow over the atrial septum at that time, when most complaints had already disappeared. This has important implications for follow-up after ablation for atrial fibrillation. (Neth Heart J 2010;18:374-5.)