Interventional Cryoablation Therapy of Paroxysmal Atrial Fibrillation in Young Patients With Low CHADS2 Score: Worth the Risk of Periprocedural and Long-Term Adverse Events?

In this study the long-term effectiveness in the cryoablation group was reported as 69.9% after 12 months, with a mean fluoroscopy exposure time of 63 min. Regarding the adverse events during follow-up, only 1 adverse event (1.2%) occurred in the drug therapy arm (transfusion because of hemorrhage) compared with 32 adverse events (14.2%) in the cryoablation group, not regarding the 24 patients who suffered temporary phrenic nerve palsy. Five strokes, 4 transient ischemic attacks, 2 cases of tamponades, 2 myocardial infarctions, 3 transfusions, 2 atriovenous fistulas, 2 pseudoaneurysms, 4 cases of persistent phrenic nerve palsy, 7 cases of pulmonary vein stenosis > 75%, and even 1 death occurred in the cryoablation arm. Therefore, there is reasonable doubt regarding the safety of the interventional AF procedures. Especially in patients with lone AF it is questionable if the benefit of the AF ablation procedures in fact outweighs their risk. Further studies are needed to assess the net-benefit of these interventional procedures. From the pulmonological point of view, serial quantitative lung perfusion scans  and serial body plethysmography are required in further prospective AF ablation trials to assess the long-term effect of mild to moderate pulmonary vein stenosis and to assess the loss of vital capacity because of phrenic nerve palsy.
Source: Journal of the American College of Cardiology - Category: Cardiology Authors: Tags: Letters to the Editor Source Type: research