THE FIRST EXPERIENCE OF CRYOABLATION USING АRTICURE CRYOICE IN KAZAKHSTAN FOR ATRIAL FIBRILLATION IN COMBINATION WITH HEART VALVE REPLACEMENT

Abstract

Introduction: Atrial fibrillation (AF) remains one of the most common arrhythmias worldwide, accounting for up to 30% of
all cardiac rhythm disorders. It leads to impaired heart function and increased risk of systemic embolism and stroke[1].
Cryoablation is currently the only energy source that does not alter collagen tissue, preserving normal tissue architecture.
This makes it an excellent energy source for ablation near valve tissue or the fibrous skeleton of the heart. Histologically, the
damage shows dense formation of uniform scars and no thrombus formation over the lesions.
Aim: To analyze the early results of cryoablation in patients with valve pathology and rhythm disturbances.
Materials and Methods: The study was conducted at the Research Institute of Cardiology and Internal Medicine from
2019 to 2022. Fifty patients underwent cryoablation using ArtiCure cryoICE in combination with valve pathology and atrial
fibrillation. All patients underwent echocardiography, transesophageal echocardiography, 24-hour Holter ECG, ECG, and
cardiac CT before and after the procedure. The clinic used the innovative technique of left atrial appendage (LAA) clipping
with AtriCLIP Flex. The cryoablation with ArtiCure cryoICE was performed in the left atrial and pulmonary vein cavities for
120 seconds, freezing the tissue to -70°C.
Results: The results were assessed through ECG and 24-hour Holter ECG readings taken at 2 days after the procedure,
before discharge, and at 3 and 6 months. After 6 months, sinus rhythm was restored in 90% of the patients, 6% had
persistent AF, and 4% (2 patients) required a permanent pacemaker implantation. The majority (80%) underwent LAA
clipping with the AtriCure system of various sizes (No. 35, 40, 45, 50). A smaller portion (20%) had LAA sutured due to
anatomical peculiarities.
Conclusions: The data from this small sample suggest a positive outcome of cryoablation using the ArtiCure cryoICE
system for open-heart surgeries in patients with atrial fibrillation.