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Long-term Outcomes of Index Cryo-balloon ablation in Patients with Atrial Fibrillation and Systolic Heart Failure
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  • Sandeep Prabhu,
  • Nikhil Ahluwalia,
  • Sara Tyebally,
  • Adam Dennis,
  • Samuel Malomo,
  • Aderonke Abiodun,
  • Agelos Tyrlis,
  • Gurpreet Dhillon,
  • Louise Segan,
  • Adam Graham,
  • Shohreh Honarbakhsh,
  • Vinit Sawhney,
  • Simon Sporton,
  • Martin Lowe,
  • Malcolm Finlay,
  • Mark Earley,
  • Pier Lambiase,
  • Richard Schilling,
  • Ross Hunter
Sandeep Prabhu
Alfred Hospital
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Nikhil Ahluwalia
Saint Bartholomew's Hospital Barts Heart Centre
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Sara Tyebally
Saint Bartholomew's Hospital Barts Heart Centre
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Adam Dennis
Saint Bartholomew's Hospital Barts Heart Centre
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Samuel Malomo
Saint Bartholomew's Hospital Barts Heart Centre
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Aderonke Abiodun
Saint Bartholomew's Hospital Barts Heart Centre
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Agelos Tyrlis
Saint Bartholomew's Hospital Barts Heart Centre
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Gurpreet Dhillon
Barts Health NHS Trust
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Louise Segan
Baker Heart and Diabetes Institute
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Adam Graham
Barts Health NHS Trust
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Shohreh Honarbakhsh
Barts Heart Centre, Barts Health NHS trust
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Vinit Sawhney
Barts Heart Centre
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Simon Sporton
Barts Heart Centre, St Bartholomew's Hospital
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Martin Lowe
Barts Health NHS Trust
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Malcolm Finlay
Barts Health NHS Trust
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Mark Earley
Barts Health NHS Trust
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Pier Lambiase
Bart's Heart Centre
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Richard Schilling
Barts and The London NHS Trust
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Ross Hunter
St Bartholomew's Hospital
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Abstract

Background: Although catheter ablation (CA) is an effective treatment for patients with AF and LVSD, the efficacy of an initial cryo-ablation strategy is unknown. This study evaluated long term outcomes of patients with an initial cryo-ablation strategy for AF and LV systolic dysfunction (LVSD). Methods: Outcomes of patients undergoing index cryoablation for AF from January 2008 until March 2018, with documented pre-ablation LVEF45% were evaluated for long term freedom from AF and change in ventricular function from baseline. Results: 76 patients met inclusion criteria. Patients were predominantly male (80%), aged 63 11yrs, with an average CHADS2 VASc score of 2.66  1.40, baseline LVEF 34  8.7% (ischaemic in 37%) and NYHA class 2.37  0.72. Repeat procedures were performed in 13%. The single procedure success was 70% at 1 year (81% for paroxysmal AF, 65% for persistent AF, 29% for long-standing persistent AF) and at 28  13 months follow up was 43% (50%, 41% and 21% respectively), increasing to 59% allowing for subsequent redo procedure with RF ablation (64%, 57%, and 50% respectively). At follow up, LVEF significantly improved to 46  16% (p<0.001), and NYHA reduced to 1.51  0.66 (p<0.001). Conclusion: An initial strategy of cryoablation in patients with AF and LVSD is an effective approach in the treatment of patients with concurrent AF and LVSD. Larger, randomised prospective studies are required to confirm these findings.

Peer review status:ACCEPTED

04 Oct 2020Submitted to Journal of Cardiovascular Electrophysiology
07 Oct 2020Submission Checks Completed
07 Oct 2020Assigned to Editor
07 Oct 2020Reviewer(s) Assigned
11 Nov 2020Review(s) Completed, Editorial Evaluation Pending
12 Nov 2020Editorial Decision: Revise Minor
28 Dec 20201st Revision Received
29 Dec 2020Submission Checks Completed
29 Dec 2020Assigned to Editor
29 Dec 2020Reviewer(s) Assigned
17 Jan 2021Review(s) Completed, Editorial Evaluation Pending
20 Jan 2021Editorial Decision: Accept