Repeat procedures after second-generation cryoballoon ablation as an index procedure for persistent atrial fibrillation: one-year follow-up

Coutiño, Hugo Enrique; Asmundis, Carlo de; Mugnai, Giacomo; Moran, Darragh; Regibus, Valentina De; Ströker, Erwin; Takarada, Ken; Ruggiero, Diego; Choudhury, Rajin; Beckers, Stefan; Gompel, Carla Van; Poelaert, Jan; Iacopino, Saverio; Filannino, Pasquale; Brugada, Pedro; Chierchia, Gian‐Battista

doi:10.1007/s10840-016-0179-5

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…If patients have recurrent AF after PVI, a second ablation is often pursued. FFAF after pulmonary vein reisolation (PVRI) remains suboptimal at 40% to 75%, with lower rates of FFAF if patients have nonparoxysmal atrial fibrillation (NPAF) before PVRI 4‐7 . There are limited data to guide ablation technique in patients who have recurrent AF after PVI 8,9 …”

Section: Introductionmentioning

confidence: 99%

Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Peigh

Wasserlauf

Kaplan

et al. 2020

Cardiovasc electrophysiol

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Introduction: Focal impulse and rotor modulation (FIRM) ablation can be used to target nonpulmonary vein (PV) sources of atrial fibrillation (AF). No published studies have compared freedom from atrial fibrillation (FFAF) after pulmonary vein reisolation (PVRI) plus FIRM to PVRI alone in patients with reconnected PVs undergoing repeat ablation. Methods: A 3:1 matched retrospective cohort study was performed on 21 patients with recurrent AF and PV reconnection who underwent PVRI plus FIRM-guided ablation and 63 patients with recurrent AF treated with PVRI alone at a single institution. All patients in the PVRI-alone cohort had cryoballoon PVRI at the time of repeat ablation without additional lesion sets for AF. Cases were matched based on the type of AF (paroxysmal vs nonparoxysmal), left atrial diameter (±4 mm), left ventricular ejection fraction (±10%), duration of AF (±18 months), and age (±5 years). The primary endpoint was FFAF after a 3-month blanking period. Results: Out of 53 total FIRM cases performed at Northwestern Memorial Hospital between 2015 and 2017, 21 patients had PVRI plus FIRM for recurrent AF with PV reconnection. These patients had an average of 3.3 ± 2.1 rotors (60% left atrial) ablated. Over a median follow-up time of 24.7 months (interquartile range, 13-36 months), patients in the PVRI-alone cohort demonstrated a higher rate of FFAF (n = 35; 55.6%) than patients in the PVRI plus FIRM-guided ablation cohort (n = 7; 33.3%) (logrank P = .049). Conclusion: In patients undergoing repeat ablation for AF with PV reconnection, PVRI plus FIRM did not increase FFAF compared to PVRI alone. K E Y W O R D S atrial fibrillation ablation, cryoballoon ablation, focal impulse and rotor modulation How to cite this article: Peigh G, Wasserlauf J, Kaplan RM, et al. Repeat pulmonary vein isolation with or without FIRM-guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection.

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Section: Introductionmentioning

confidence: 99%

Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Peigh

Wasserlauf

Kaplan

et al. 2020

Cardiovasc electrophysiol

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“…Since atrial flutter can occur following PVI, it is important to understand the pattern of post-CBA-PVI atrial flutter [6]. There are limited data describing the incidence and intracardiac origin of atrial flutters following CBA-PVI [7,8]. One smaller study of routine rhythm monitoring after first-time CBA-PVI found the post-CBA-PVI atrial flutter incidence as confirmed by EPS is 5.6% (4 of 181 patients) with mean follow-up 16.6 months.…”

Section: Introductionmentioning

confidence: 99%

Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation

Baman

Kaplan

Diaz

et al. 2019

J Interv Card Electrophysiol

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Purpose-Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter. Methods-We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps. Results-There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4% were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5%) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60%) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60% being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50% (OR 3.36, p = 0.007). Conclusions-The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.

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Linear lesions for treating the recurrence of persistent atrial tachyarrhythmia after cryoballoon ablation of atrial fibrillation

Hermida

Fay

Kubala

et al. 2022

Archives of Cardiovascular Diseases

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Repeat procedures after second-generation cryoballoon ablation as an index procedure for persistent atrial fibrillation: one-year follow-up

Cited by 3 publications

References 23 publications

Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation

Linear lesions for treating the recurrence of persistent atrial tachyarrhythmia after cryoballoon ablation of atrial fibrillation

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