Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-195 - Cryoballoon Versus Radiofrequency Based Pulmonary Vein Isolation In Obese Patients: Results Of A Single-center Analysis (ID 250)

Abstract

Background: Pulmonary vein isolation (PVI) is a standard therapy for patients (pts) with symptomatic atrial fibrillation (AF). For PVI a cryoballoon (Cryo) or radiofrequency (RF) based ablation is applicable with comparable success rates.
Objective: We assessed the impact of BMI on AF recurrence and procedural characteristics in Cryo and RF based PVI.
Methods: All patients undergoing de novo PVI between 01/2018 and 09/2019 at University Hospital Cologne were included in this retrospective analysis. We predefined subgroups based on BMI [kg/m²]: normal weight BMI <25, pre-obesity 25-30, obesity stage I 30-35 and obesity stage II ≥35 and compared Cryo vs RF based PVI.
Results: In total 546 de novo PVI (332 Cryo, 61% and 214 RF, 39%) were performed successfully. The BMI distribution (BMI <25, 25-30, 30-35, ≥35) was: Cryo: 100 (30%), 125 (38%), 72 (22%) and 35 (10%) pts, RF: 72 (34%), 89 (42%), 37 (17%) and 16 (7%). As a major finding, the procedure time [min] for a Cryo PVI was significantly shorter compared to RF based PVI in all BMI groups (Cryo 80.6 vs RF 140.7, p<0.001). This effect was particularly driven by obese pts (BMI≥35: Cryo 86.4 vs RF 150.6, p=0.004). Expectably, the amount of contrast medium [ml] was higher in the Cryo group (all pts: Cryo 57.2 vs RF 11.1, p<0.001; BMI≥35: Cryo 72.8 vs RF 6.9, p<0.001). Based on the usage of 3D mapping systems a lower fluoroscopy dose [μGy x m²] was detected in the RF group compared to a non-3D guided Cryo PVI regardless of BMI (all pts: Cryo 695.1 vs RF 426.0, p<0.001; BMI≥35: Cryo 1420.2 vs RF 786.6, p=0.008). Freedom from AF recurrence until 3 month follow up (available in 380 (70%) pts) was comparable in Cryo and RF regardless of BMI (Cryo: all pts 67%, BMI<25 63%, BMI≥35 65%; RF: all pts 70%, BMI<25 70%, BMI≥35 55%; BMI<25: p=0.47, BMI≥35: p=0.55). The complication rate did not show any differences regardless of BMI.
Conclusion: Cryo PVI is equally safe and effective in obese pts compared to RF based PVI. In comparison, the procedure time is significantly shorter for the Cryo group and therefore may minimize possible obesity related complications (e.g. aspiration, apnea and infections). Randomised trials are needed to evaluate the long-term outcome in pts with higher BMI comparing Cryo vs RF based PVI and possible obesity related complications.
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