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Preventing atrial fibrillation by combined right isthmus ablation and cryoballoon pulmonary vein isolation in patients with typical atrial flutter: the PAF-CRIOBLAF study
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  • Frederic Anselme,
  • Arnaud Savoure,
  • Nicolas Clementy,
  • Olivier Cesari,
  • Dominique Pavin,
  • Laurence Jesel,
  • Pascal DEFAYE,
  • Serge Boveda,
  • Jean-Pierre Cebron,
  • Jacques Mansourati,
  • Alexis Mechulan,
  • Gilles Lande,
  • Michael Bubenheim,
  • Antoine Milhem,
  • Philippe Rivat
Frederic Anselme
Hôpital Charles Nicolle
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Arnaud Savoure
Rouen University Hospital
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Nicolas Clementy
Centre Hospitalier Régional Universitaire de Tours
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Olivier Cesari
Clinique Saint-Gatien
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Dominique Pavin
Rennes University Hospital
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Laurence Jesel
Centre Hospitalier Universitaire de Strasbourg
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Pascal DEFAYE
Grenoble University Hospital
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Serge Boveda
Clinique Pasteur
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Jean-Pierre Cebron
Confluent Nouvelles Cliniques Nantaises
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Jacques Mansourati
University hospital La Cavale Blanche
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Alexis Mechulan
Ramsay Général de Santé
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Gilles Lande
Centre Hospitalier Universitaire de Nantes
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Michael Bubenheim
Centre Hospitalier Universitaire de Rouen
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Antoine Milhem
Centre hospitalier de la Rochelle
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Philippe Rivat
Centre Hospitalier de Valenciennes
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Abstract

Aims - Although less common, typical atrial flutter (AFL) shares similar pathophysiologic roots with atrial fibrillation (AF). Following successful cavo-tricuspid isthmus ablation using radiofrequency (RF), many patients, however, develop AF in the mid-to-long-term. This study sought to assess whether pulmonary vein isolation (PVI) conducted at the same time as cavo-tricuspid isthmus ablation would significantly modify the AF burden upon follow-up (FU) in patients suffering from typical AFL. Methods - This was a multicenter randomized controlled study involving AFL patients with history of non-predominant AF (1 AF episode only in 67% of population) who were scheduled for CTI RF ablation. Patients were randomly assigned to either undergo cavo-tricuspid isthmus (CTI) ablation alone or CTI plus PVI (CTI+). PVI was performed using cryoballoon technology. An outpatient consultation with ECG and 1-week Holter monitoring was performed at 3, 6 months, 1 year, and 2 years post-procedure. The primary endpoint was AF recurrences lasting more than 30 s at 2 years post-ablation. Results - Of the patients enrolled, 36 were included in each group. At 2-year FU, the AF recurrence rate was significantly higher in the CTI versus CTI+ group (25/36, 69% vs. 12/36, 33% respectively; p<0.001), with similar AFL recurrence rates. There were no differences in quality of life or undesirable events, except for transient phrenic nerve palsy reported from three PVI patients (8.3%). Conclusion - PVI using cryoballoon technology was proven to significantly reduce the AF incidence at 2 years post-CTI-ablation.