Reablation in Atrial Fibrillation Recurrence and Pulmonary Vein Reconnection: Cryoballoon versus Radiofrequency as Index Ablation Procedures

Abstract

Pulmonary vein (PV) isolation is a well-established rhythm control therapy in atrial fibrillation (AF). Currently, there is no consensus on which ablation technique to use for the first procedure, cryoballoon (CB) or radiofrequency (RF). A retrospective cohort study was conducted on 1055 patients who underwent a first ablation, to assess both techniques based on the need for reablation. Patients with CB (n = 557) and RF (n = 498) ablations were clinically characterized and the need for reablation during a 30-month follow-up was used as the primary endpoint. Independent variables were analyzed to identify potential predictors. The need for reablation was significantly lower in the CB group than in the RF group (hazard ratio = 0.45 and 95% confident interval = 0.32–0.61; p < 0.001); in both paroxysmal and persistent AF, using a full-adjusted regression Cox model by age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, severe obstructive sleep apnea, dilated left atrium, persistent AF and early recurrence. RF ablation, dilated left atrium, persistent AF and early recurrence were identified as independent predictors of reablation. In addition, the CB-redo subgroup had a lower PV reconnection than the RF-redo subgroup. In conclusion, CB ablation suggests a reduction in the need for reablation and lower PV reconnection during the follow-up than RF ablation.

Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis

“…This study is derived from a multicenter retrospective cohort study that included a total of 1055 consecutive patients who underwent their first catheter ablation procedure for symptomatic paroxysmal or persistent AF using point-by-point radiofrequency (RF) or single-shot cryoballoon (CB) and were refractory to one or more anti-arrhythmic drugs [ 13 ]. The following exclusion criteria were applied: patients under 18 years of age, refusal of informed consent, patients with asymptomatic AF, absence of previous anti-arrhythmic medication, or patients who had undergone a previous ablation procedure.…”

“…A CTscan was previously performed to assess the anatomy of the PVs. For more details see Molina-Ramos et al [13].…”

Acute and long-term results with the 3rd generation visually guided laser balloon ablation system for pv isolation

“…No other major complications occurred during and after the procedure through 1 year of follow-up. [1] Defined as the time from venous access to the time of withdrawal of the HeartLight Catheter [2] Defined as the time from transseptal puncture to withdrawal of the HeartLight Catheter [3] Defined as the time from the insertion of the HeartLight Catheter to the time of withdrawal of the Hear-tLight Catheter [4] Defined as the % of patients where all veins attempted were isolated with the X3 catheter [5] Defined as the % of patients where all veins attempted were isolated with the X3 catheter and only 1 mapping/vein [6]…”

“…Radiofrequency (RF) ablation was first established and played a key role in AF ablation, especially RF PV isolation which has been recognized as an optimal therapeutic option [1][2][3]. The conventional RF procedure requires experience in catheter handling and output power control, but PV reconnections have been recently reported to occur between 30 and 50% among recurrent AF patients even with highly integrated lesion quality markers/index RF ablation [4][5][6]. Moreover, overheating of RF applications may create thrombus or steam pops leading to major complications such as ischemic stroke or cardiac tamponade [7].…”