Clinical Curative Efficacy Of "ICE And FIRE" Ablation For Atrial Fibrillation

Objective: Cryoablation has been shown to be safe and effective for paroxysmal atrial fibrillation,but the single size of balloon and the variety of pulmonary vein anatomy provide a challenge to achieve complete pulmonary vein isolation(PVI),so often requires a combination of radiofrequency ablation to achieve PVI.And for persistent atrial fibrillation,extensive atrial substrate modification is mainly dependent on radiofrequency under three-dimensional mapping.So,our electrophysiological team adopted the ablation strategy combined with cryoablaton and radiofrequency,that is using cryoballoon for PVI or freeze left atrial roof combined radiofrequency ablation for gaps or liner ablation,we called it“ICE plus FIRE” ablation.In this present study,we explore the clinical curative efficacy of RF,CB,and “ICE and FIRE” ablation for treatment of paroxysmal atrial fibrillation and persistent atrial fibrillation.Methods: Form March 2016 to December 2017,the patients with paroxysmal atrial fibrillation and persistent atrial fibrillation who underwent catheter ablation in Second Hospital Affiliated to Tianjin Medical University were recruited.The patients were divided into radiofrequency ablation group(RF),cryoballoon ablation group(CB)and “ICE plus FIRE” group(CB+RF)according to ablation energy.Patients were followed up at 1,2,3,6,and 12 months through outpatient service or telephone consultation.The procedural time,amount of X-ray exposure and follow-up efficacy were compared between the RF,CB and CB+RF groups.Result:(1)The study was included 65 patients with paroxysmal atrial fibrillation,20 in the RF group,38 in the CB group and 7 in the CB+RF group.The operation time of group CB was significantly lower than group RF and group CB+RF(P<0.001),but there was no difference between group RF and CB+RF(P=0.5).There was no significant difference in X-ray exposure in RF,CB and CB+RF groups [(670.2±550.4)m Gy vs.(685.6±1031.2)m Gy vs.(921.0±1201.2)m Gy,P=0.83].In the 3 month blank period,there was no significant difference in the early recurrence rate between the 3 groups(P=0.68).Follow-up of 10.6±6.1 months,the success rates of RF,CB and CB+RF were 70%,81.6% and 85.7%,respectively.Although the success rate of group CB and group CB+RF was higher than group RF,there was no significance difference between the three groups(P=0.64).(2)The study was included 22 patients with persistent atrial fibrillation,11 in the RF group,5 in the CB group and 6 in the CB+RF group.The operation time of group CB was significantly lower than group RF [(137.0±22.2)min vs.(208.6±71.1)min,P=0.045] and group CB+RF [(137.0±22.2)min vs.(242.0±61.7)min,P=0.011],but there was no statistical difference between group RF and CB+RF(P=0.3).There was no significant difference in X-ray exposure in RF,CB and CB+RF groups [(706.1±554.0)m Gy vs.(801.0±973.7)m Gy vs.(758.7±434.8)m Gy,P=0.96].In the 3 month blank period,there was no significant difference in the early recurrence rate between the 3 groups(P>0.05).Follow-up of 10.4±6.1 months,the success rates of RF,CB and CB+RF were 63.6%,80% and 66.7%,there was no statistical difference(P=0.72).Conclusion: Cryoablation and radiofrequency ablation can achieve the same clinical efficacy in paroxysmal atrial fibrillation,but it can reduce operative time and not increase X-ray exposure.Single cryoablation may be an alternative ablation strategy for patients with persistent atrial fibrillation who atrial fibrillation can be terminate during the operation.Cryoablation combined with radiofrequency ablation for gaps or linear ablation is an optimized procedure for patients with atrial fibrillation who failure to complete PVI or terminate atrial fibrillation by using cryoballoon alone.