Thursday, June 2, 2016

Cryoballoon Versus Radiofrequency Ablation For Paroxysmal Atrial Fibrillation: Review Of Current Literature 

Syed Rafay Ali Sabzwari, MD; Dhanunjaya Lakkireddy, MD, FACC, FHRS

Atrial fibrillation is the most common arrhythmia affecting an estimated 3 million people in US and 20 million around the world. In the realm of rhythm control antiarrhythmic drugs (AAD) were utilized until transcatheter ablation techniques emerged. Circumferential pulmonary vein isolation (PVI) is the standard and recommended approach for catheter ablation of paroxysmal atrial fibrillation refractory to medical therapy. The first introduced and most commonly used method is radiofrequency (RF) ablation and the second most common and more recent is cryoballoon (CB) ablation. To benefit from their efficacies and optimize their usage, in the past there have been many mostly nonrandamoised single center prospective registries showing equivocal efficacy of the two techniques with slightly lower complications such as cardiac tamponade and perforation with cryoballoon technique. However in addition to the three prior randomized controlled trials, the recently published FIRE and ICE Trial by Kuck et al1 which is a large, multicenter, randomized trial compared radiofrequency and cryoballoon techniques used for ablation of paroxysmal atrial fibrillation. 
Rate Control Vs Rhythm Control For Atrial Fibrillation After Cardiac Surgery: Review Of Current Literature

Syed Rafay Ali Sabzwari, MD; Dhanunjaya Lakkireddy, MD, FACC, FHRS

Atrial fibrillation (AF) after cardiac surgery is a common phenomenon reaching an incidence of 20-50% with a significant toll on postoperative complications, hospital stay, readmission and utilization of resources. Such patients have increased morbidity from stroke, myocardial infarction, congestive heart failure, arrhythmias from antiarrhythmic drugs and bleeding caused by anticoagulant use. Although there have been multiple studies done in the past to address post cardiac surgery atrial fibrillation majority of them focused on prevention strategies using prophylactic measures. The AFFIRM trial7 addressed rate vs rhythm control in nonsurgical patients, however conclusive evidence of whether this could be extrapolated to post cardiac surgery atrial fibrillation was lacking. This article explores the current literature on post cardiac atrial fibrillation rate versus rhythm control.