THE FIRST EXPERIENCE OF CRYOABLATION USING АRTICURE CRYOICE IN KAZAKHSTAN FOR ATRIAL FIBRILLATION IN COMBINATION WITH HEART VALVE REPLACEMENT
Introduction: Atrial fibrillation (AF) remains one of the most common arrhythmias worldwide, accounting for up to 30% of all cardiac rhythm disorders. It leads to impaired heart function and increased risk of systemic embolism and stroke[1]. Cryoablation is currently the only energy source that does not alter collagen tissue, preserving normal tissue architecture. This makes it an excellent energy source for ablation near valve tissue or the fibrous skeleton of the heart. Histologically, the damage shows dense formation of uniform scars and no thrombus formation over the lesions.
Aim: To analyze the early results of cryoablation in patients with valve pathology and rhythm disturbances.
Materials and Methods: The study was conducted at the Research Institute of Cardiology and Internal Medicine from 2019 to 2022. Fifty patients underwent cryoablation using ArtiCure cryoICE in combination with valve pathology and atrial fibrillation. All patients underwent echocardiography, transesophageal echocardiography, 24-hour Holter ECG, ECG, and cardiac CT before and after the procedure. The clinic used the innovative technique of left atrial appendage (LAA) clipping with AtriCLIP Flex. The cryoablation with ArtiCure cryoICE was performed in the left atrial and pulmonary vein cavities for 120 seconds, freezing the tissue to -70°C.
Results: The results were assessed through ECG and 24-hour Holter ECG readings taken at 2 days after the procedure, before discharge, and at 3 and 6 months. After 6 months, sinus rhythm was restored in 90% of the patients, 6% had persistent AF, and 4% (2 patients) required a permanent pacemaker implantation. The majority (80%) underwent LAA clipping with the AtriCure system of various sizes (No. 35, 40, 45, 50). A smaller portion (20%) had LAA sutured due to anatomical peculiarities.
Conclusions: The data from this small sample suggest a positive outcome of cryoablation using the ArtiCure cryoICE system for open-heart surgeries in patients with atrial fibrillation.
Zhanar N. Nurbay1,2, https://orcid.org/0000-0002-2020-3353
Rustem M. Tuleutayev1, https://orcid.org/ 0000-0002-6003-3010
Marat O. Pashimov1, https://orcid.org/0009-0004-9316-9549
Aueshan T. Djumabekov2, https://orcid.org/ 0000-0002-35024411
Maxat A. Zhakayev1, https://orcid.org/ 0000-0003-2634-4584
1 AO "Scientific Research Institute of Cardiology and Internal Medicine", Almaty c., Republic of Kazakhstan;
2 Kazakh Medical University "Kazakhstan School of Public Health", Almaty c., Republic of Kazakhstan.
1. Ad N., Henry L., Hunt S. The concomitant cryosurgical Cox- Maze procedure using Argon based cryoprobes: 12-month results // J Cardiovasc Surg (Torino). 2011. 52(4): 593-599.
2. Camm C.F., Nagendran M., Xiu P.Y., Maruthappu M. How effective is cryoablation for atrial fibrillation during concomitant cardiac surgery? // Interact Cardiovasc Thorac Surg. 2011. 13(4):410-414. doi: 10.1510/icvts.2011.271676.
3. Chugh S.S., Havmoeller R., Narayanan K. Worldwide epidemiology of atrial fibrillation a global burden of disease 2010 study // Circulation. 2014. 129: 837-847. doi: 10.1161/ CIRCULATIONAHA.113.005119.
4. Damiano R.J., Schwartz F.H., Bailey M.S., Maniar H.S., Munfakh N.A., Moon M.R., et al. The Cox maze IV procedure: predictors of late recurrence // J Thorac Cardiovasc Surg. 2011. 141(1):113-121. doi: 10.1016/j.jtcvs.2010.08.067.
5. Expert Committee of Atrial Fibrillation Prevention and Treatment of Specialized Committee Heart Rhythm of Chinese Medical Doctor Association, China Society of Pacing and Electrophysiology. The current understanding and treatment suggestions for atrial fibrillation // Chin J of Cardiac Arrhyth. 2015. 19(5):321-384.
6. Funatsu T., Kobayashi J., Nakajima H., Iba Y., Shimahara Y., Yagihara T. Long-term results and reliability of cryothermic ablation-based maze procedure for atrial fibrillation concomitant with mitral valve surgery // Eur J Cardiothorac Surg. 2009. 36(2):267-271. doi:10.1016/j.ejcts.2009.03.032.
7. Garrido M.J., Williams M., Argenziano M. Minimally invasive surgery for atrial fibrillation: toward a totally endoscopic, beating heart approach // J Card Surg. 2004. Vol.19(3). P 216-220.
8. Higuchi K. A modified cryo-maze procedure via the superior transseptal approach // Asian Cardiovasc Thorac Ann. 2015. 23(1):114-116. doi: 10.1177/0218492313519116.
9. Kim J.B., Bang J.H., Jung S.H., Choo S.J., Chung C.H., Lee J.W. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation // Ann Thorac Surg. 2011. 92(4):1397-1404. doi: 10.1016/j.athoracsur.2011.05.066.
10. Lee R., Mc Carthy P.M., Wang E.C., Vaduganathan M., Kruse J., Malaisrie S.C. et al. Midterm survival in patients treated for atrial fibrillation: a propensity-matched comparison to patients without a history of atrial fibrillation // J Thorac Cardiovasc Surg. 2012. 143(6):1341-1351. doi: 10.1016/j. jtcvs.2012.02.006.
11. Melby SJ, Schuessler RB, Damiano RJ. Ablation technology for the surgical treatment of atrial fibrillation. ASAIO J. 2013;59(5):461-468.
12. Nattel S. New ideas about atrial fibrillation 50 years on // Nature. 2002. Vol. 415. P. 219-226
13. Pedersen O.D., Bagger H., Keller N. et al. Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish investigation of arrhythmia and mortality on dofetilide (DIAMOND) substudy // Circulation. 2001. Vol. 104. P 292-296.
14. Obadia J. F., El Farra M., Bastien O. H. et al. Outcome of atrial fibrillation after mitral valve repair // J. Thorac. Cardiovasc. Surg. 1997. Vol. 114. P. 179-185.
15. Vasamreddy C.R., Lickfett V.K., Jayam L. et al. Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter // J Cardiovasc Electrophysiol. 2004. Vol. 15(6). P. 692-7.
16. Yanagawa B., Holmes S.D., Henry L., Hunt S., Ad N. Outcome of concomitant Cox-maze III procedure using an argon- based cryosurgical system: a single-center experience with 250 patients // Ann Thorac Surg. 2013. 95(5):1633-1639. doi: 10.1016/j.athoracsur.2013.02.015.
17. January C.T., Wann L.S., Alpert J.S., Calkins H., Cigarroa J.E., Cleveland J.C. et al. AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society // J Am Coll Cardiol. 2014. 64(21):e1-76. doi: 10.1016/j.jacc.2014.03.022.
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Nurbay Zh.N., Tuleutayev R.M., Pashimov M.O., Djumabekov A.T., Zhakayev M.A. The first experience of cryoablation using Аrticure cryoice in Kazakhstan for atrial fibrillation in combination with heart valve replacement // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 3, pp. 40-46. doi 10.34689/SH.2023.25.3.005Related publications:
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