Comparison of the efficacy and safety of pulmonary vein cryoballoon ablation alone and with additional isolation of the superior vena cava in patients with persistent atrial fibrillation

Aim . To study the impact and safety of cryoballoon ablation of the pulmonary vein (PV), supplemented by isolation of the superior vena cava in patients with persistent atrial fibrillation (AF). Methods . The study is single-center, randomized, prospective. The total number of patients was 40. All of them underwent cryoballoon isolation of the PV for persistent AF. The patients were then divided into two groups: the first group included patients who underwent the standard procedure, and the second group included patients with the standard procedure supplemented by isolation of the superior vena cava. Patients in both groups had similar anatomical and clinical-anamnestic parameters. The duration of the surgical intervention was not statistically different. Results . The average follow-up period was 354±19 days. In the group of classical cryoballoon PV isolation, after 12 months of observation without antiarrhythmic therapy, sinus rhythm was maintained in 40% of patients (8 people), in the group of extended cryoballoon PV isolation - in the same number of patients (40%, P=1). In the PV isolation group, persistent phrenic nerve palsy was observed in no patients, and in the extended ablation group, in eight patients (40%, P=0.0016). At the end of the observation, no remote complications were registered. Conclusions . In patients with persistent AF, cryoballoon PV isolation supplemented by superior vena cava isolation is a less safe technique than standard cryoballoon pulmonary vein isolation, with comparable efficacy.