Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Abstract

Background: Pulmonary vein isolation (PVI) using phased radiofrequency (RF) energy has been shown to be effective in the treatment of atrial fibrillation (AF). Methods: We characterize and compare pulmonary vein (PV) reconnection at repeat ablation in patients with AF after initially successful PVI using phased RF technology (PVAC) or 2nd generation cryoballoon (CB). Eighty five patients undergoing redo PVI using multielectrode PVAC phased RF catheter and 66 patients after CB PVI were enrolled 9.7 ± 3.4 months after the initial ablation procedure. Results: The percentage of patients with PV reconnection(s) was comparably high between both groups (93% PVAC and 92% CB). However, 75% of all PVs and left common trunks (CTs) isolated with PVAC were reconnected, compared with 52% reconnections after CB PVI (p < 0.001). A mean of 2.79 ± 1.2 PVs and CTs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, p < 0.0001. No patients in the CB group had 4 reconnected PVs, while this pattern of reconnection was observed in 33% in the PVAC group (p < 0.0001). The percentage of patients in the PVAC group with ≥3 reconnected PVs was significantly higher compared with CB patients (56 patients (66%) vs. 17 patients (26%), p < 0.0001), while the percentage of patients with no PV reconnection was comparably low in PVAC and CB patients (7 and 8%, respectively). CTs were most frequently reconnected after PVAC PVI (94%) and left superior PVs after CB ablation (67%), respectively. Conclusions: The number of patients with recurrent AF and PV reconnection(s) at redo PVI was comparably high between both groups. However, the extent and distribution of PV reconnections was different in many aspects, indicating more stable atrial lesions after CB PVI compared with PVAC technology.

The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies

“…However, the one year followup after PVI with this system revealed high rates of reconnection of multiple PVs in those with AF recurrence [6]. Similar findings have been reported in a comparison study of reconnection patterns with the cryoballoon [26]. The authors describe, for example, the reconnection of all four veins in 33% of the PVAC patients compared to 0% in the cryoballoon group, stipulating that our three groups showed comparable degrees of atrial substrate.…”

2-year outcomes of phased radiofrequency ablation for atrial fibrillation with the second-generation PVAC Gold ablation catheter

“…Comparison between RFA and CBA was done in the FIRE&ICE redo study, concluding that patients with one or more reconnected vein(s) were distributed equally (83% for RFA and 78% for CBA), although the number of reconnected veins was higher in the RFA cohorts [ 19 ]. Wieczorek et al investigated reconnection after PVAC and 2nd generation CBA, and although comparable high rates of reconnection in patients with recurrent AF were seen, significantly more PVs showed reconnection in the PVAC group [ 20 ]. De Pooter et al showed that in patients after CLOSE-guided PVI, during repeat ablation in only 48% of patients one or more PVs showed reconnection [ 14 ].…”

Atrial fibrillation ablation: the position of computed tomography in pre-procedural imaging

“…In terms of safety and long-term effects, CBA is comparable with classical point-by-point radiofrequency (RF) ablation [51][52][53][54][55][56][57]. Moreover, the CBA procedure duration is significantly shorter, with lower number of repeated procedures and with less reconnected veins [58][59][60][61][62][63][64][65]. However, the AF ablation with cryoballoon technique is more dependent upon pulmonary veins anatomy.…”