{"id":"12a92fe12c35","type":"article","url":"https://hartvaat.nl/2023/02/14/cryoballon-pvi-als-eerstelijnsbehandeling-voor-typisch-atriumflutter/","title":"Cryoballon PVI als eerstelijnsbehandeling voor typisch atriumflutter","title_en":"Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie","pulmonaalvenenisolatie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321729","source_url":"https://doi.org/10.1136/heartjnl-2022-321729","authors":["Dhiraj Gupta","Wern Yew Ding","Peter Calvert","Emmanuel Williams","Moloy Das","Lilith Tovmassian","Muzahir H Tayebjee","Guy Haywood","Claire A Martin","Kim Rajappan","Matthew G D Bates","Ian Peter Temple","Tobias Reichlin","Zhong Chen","Richard N Balasubramaniam","Christina Ronayne","Nichola Clarkson","Maureen Morgan","Janet Barton","Ian Kemp","Saagar Mahida","Christian Sticherling"],"significance":7,"published":"2023-02-14","source_date":"2023-02-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/atriumflutter/","https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"This study compared cryoballoon pulmonary vein isolation with standard CTI ablation as first-line treatment for typical atrial flutter, finding that PVI provides additional AF prevention while treating the flutter, potentially offering a more comprehensive rhythm strategy.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht cryoballon PVI versus standaard CTI-ablatie als eerstelijnsbehandeling voor typisch atriumflutter. PVI verminderde recidief-atriale aritmieën (inclusief AF) meer dan CTI-ablatie alleen, wat een bredere initiële ablatiestrategie ondersteunt.","abstract_original":"OBJECTIVE: We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). METHODS: Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy. RESULTS: Trial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61-71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000). CONCLUSION: Cryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF. TRIAL REGISTRATION NUMBER: NCT03401099."}