Differences in the electrophysiological findings of repeat ablation between patients who first underwent cryoballoon ablation and radiofrequency catheter ablation for paroxysmal atrial fibrillation

Abstract

Introduction Several studies have revealed that second‐generation cryoballoon (CB)‐based pulmonary vein (PV) isolation is noninferior to radiofrequency (RF)‐based PV isolation for patients with drug‐refractory paroxysmal atrial fibrillation (AF). However, electrophysiological differences in repeat ablation remain unclear. Methods and Results This study examined electrophysiological differences during the repeat ablation between patients who first underwent RF catheter ablation and CB ablation; PV durability and non‐PV AF foci were assessed for these patients. We enrolled 919 and 491 patients who underwent CB ablation (CB group) and RF catheter ablation (RF group), respectively, for paroxysmal AF between January 2013 and June 2017 at our institution. PV isolation using RF ablation involved the left atrium (LA) antrum and part of the LA posterior wall. After 2 years of follow‐up, 62 and 80 patients in the CB and RF groups, respectively, underwent repeat ablation. PV reconnections were more frequent in the RF group than in the CB group (left superior PV: 46.2% and 14.5%, P < .001; left inferior PV: 35.0% and 11.2%, P = .001; right superior PV: 40.0% and 22.6%, P = .031; right inferior PV: 36.2% and 19.4%, P = .039; PVs: 39.8% and 16.9%, P < .001). LA AF foci were more frequent in the CB group than in the RF group (27.4% and 7.5%; P = .002). Other non‐PV foci were prevalent in both groups. Conclusion Fewer LA‐PV reconnections occurred with CB ablation. However, extensive PV isolation may eliminate many LA AF foci.

Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation

“…Procedural management at our hospital has been previously reported [7] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . Blood tests, chest radiography, and electrocardiography were performed preoperatively.…”

“…The mapping catheter’s distal portion was placed in the CS and cavotricuspid isthmus, with the proximal portion in the crista terminalis and SVC. The CA protocol has recently been described [7] , [14] , [17] . In patients undergoing PVI with RF, an 8.5-Fr long sheath (SL0; Abbott Medical, Minneapolis, MN, USA) and 11.5-Fr steerable sheath (Agilis; Abbott Medical) were inserted through the right femoral vein, while an 8.5-Fr long sheath (SL0) and a 15-Fr steerable sheath (FlexCath Advance; Medtronic, Minneapolis, MN, USA) were inserted in patients undergoing PVI with CB ablation.…”

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation

“…Herrera 19 found that both CA and RFA energy would result in a comparable increase in cell damage, but CA did not show an improved safety profile or success rate. Inamura 20 found that patients who first underwent CA for PAF had fewer LA‐PV reconnections but more frequent LA AF foci than those who underwent RFA after 2 years of follow‐up. It was even observed that myocardial injury markers were significantly higher in patients with CA than with RFA, and a longer delivery energy duration and a larger lesion size might be the reason 21 .…”

Ablation of persistent atrial fibrillation: Challenges and solutions

“…Recent data on the second generation cryoballoon suggests that reconnection rates are 19% to 50%. [19][20][21][22] A 3 month remapping study using the laser balloon showed a reconnection rate of 21%. 23 There is also evidence to suggest that the decrease in PV reconnection rates with contemporary catheter ablation technologies is driving better outcomes in persistent AF ablation.…”

“…Newer generation cryoballoons and visually‐guided laser balloons are also helping to drive lower PV reconnection rates. Recent data on the second generation cryoballoon suggests that reconnection rates are 19% to 50% . A 3 month remapping study using the laser balloon showed a reconnection rate of 21% …”