Left atrial appendage isolation with cryoballoon may work as an adjunctive strategy for persistent AF treatment

Ugur Canpolat and Kudret Aytemir

Researchers in Turkey have found that additional left atrial appendage (LAA) isolation using second generation cryoballoon technology is feasible and safe and that it may be considered as an adjunctive therapy to pulmonary vein isolation for persistent atrial fibrillation (AF) treatment.


The research, led by Ugur Canpolat and Kudret Aytemir (Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey), was presented as an abstract at the AF Symposium (14-16 January, Orlando, USA). According to the authors, “This is the first study evaluating LAA isolation with cryoballoon technology.”

“The LAA has been considered as an additional AF trigger site beyond the pulmonary veins and named as the fifth pulmonary vein. Circumferential isolation of LAA using radiofrequency energy is dangerous because of risk of perforation in thin walled LAA,” argumented Canpolat and colleagues. “There has not been a study evaluating the feasibility of cryoballoon for LAA isolation,” the authors said. Therefore, they aimed to evaluate the feasibility and safety of cryoballoon-based isolation of LAA as an adjunct to pulmonary vein isolation.

Between July and October 2015, Canpolat et al performed pulmonary vein isolation and additional LAA isolation with cryoballoon technology (Arctic Front Advance, Medtronic) in 20 patients with persistent AF who were resistant to antiarrhythmic drugs. All the patients included in the study have had pre-procedural LAA potentials.

The researchers reported 98.8% of the pulmonary veins were successfully isolated and the LAA was successfully isolated in 65% of the patients. They noted that LAA isolation was achieved at a median -42°C (range: -34°C and -54°C) and median 322 seconds (range: 70-400 seconds). There were no minor or major complications related with the procedure including phrenic nerve paralysis and access site problems and no mechanical dysfunction of the LAA among study patients, Canpolat et al highlighted. However, they said “there may be balloon-LAA mismatch in some patients, which makes LAA isolation impossible despite lower temperatures.”

The authors concluded: “Additional left atrial appendage electrical isolation using secondary generation cryoballoon is feasible, safe and may be considered as an adjunctive strategy to pulmonary vein isolation for ablation of persistent atrial fibrillation. The long-term outcomes of this hybrid approach remain to be evaluated in a prospective and larger series of patients.”

Canpolat and Aytemir told Cardiac Rhythm News they are currently undergoing a study comparing pulmonary vein isolation alone with combination of pulmonary vein isolation and LAA isolation. Additionally, they are also performing a study comparing Arctic Front Advance vs. Arctic Front Advance ST for isolation of LAA in addition to pulmonary vein isolation.