Repeat procedures for recurrent persistent atrial fibrillation: A propensity‐matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon

Abstract

Aims To evaluate the clinical outcome in patients undergoing repeat procedures for recurrent persistent atrial fibrillation following an index cryoballoon (CB‐A) pulmonary vein isolation ablation on a mid‐term follow‐up of 12 months. Methods In this propensity score‐matched comparison, 50 patients undergoing left atrial posterior wall isolation (LAPWI) with the CB‐A were matched to 50 patients treated with additional linear ablation using radiofrequency catheter ablation (RFCA). Results Meantime to repeat the procedure was 9.74 ± 4.36 months. At 12 months follow‐up freedom from atrial tachyarrhythmias (ATas) was achieved in 82% of patients in the LAPWI group and in 62% of patients in the linear ablation group (P = .03). Regression analysis demonstrated that relapses during the blanking period and LA dimensions were independent predictors of ATas recurrences following the repeat procedure. Conclusion LAPWI using CB‐A is associated with a significantly higher freedom from atrial arrhythmias when compared with the RFCA mediated left atrial linear lesions on a mid‐term follow‐up of 12 months in patients with persAF undergoing a redo procedure.

Feasibility and safety of left atrial posterior wall isolation with a new Cryoballoon technology in patients with persistent atrial fibrillation

“…In order to achieve the LAPWI, the lumen mapping catheter was placed deeply in the LSPV to stabilize the CB‐A. As per our standard protocol, cryothermal lesions lasted 120 s 5–8,14 . The first cryoapplication was performed partially overlapping LSPV ostium.…”

“…5,14 In order to achieve the LAPWI, the lumen mapping catheter was placed deeply in the LSPV to stabilize the CB-A. As per our standard protocol, cryothermal lesions lasted 120 s. [5][6][7][8]14 The first cryoapplication was performed partially overlapping LSPV ostium. By a slight clockwise rotation and progressive "pullback" of the sheath while keeping the CB in contact with the posterior wall, consecutive overlapping freezes were applied along the LAPW.…”

“…Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation 1,2 . Left atrial posterior wall isolation (LAPWI) in addition to PVI by the means of the Arctic Front (Medtronic, Arctic Front Advance) cryoballoon (CB‐A) has shown promising results in patients presenting with persistent (PersAF) 3–8 …”

“…1,2 Left atrial posterior wall isolation (LAPWI) in addition to PVI by the means of the Arctic Front (Medtronic, Arctic Front Advance) cryoballoon (CB-A) has shown promising results in patients presenting with persistent (PersAF). [3][4][5][6][7][8] Recently, a novel Cryoballoon ablation system (POLARx™; Boston Scientific) has been launched on the market. 9 Although there are initial safety and efficacy data for PVI, [10][11][12] only one case report on LAPWI with this new technology is reported till now.…”

Atrial Fibrillation Global Changes after Pulmonary Vein and Posterior Wall Isolation: A Charge Density Mapping Study

“…The standard pre-procedural management and ablation with CB have been previously described in detail [ 18 , 19 , 20 ]. With the exception of amiodarone, antiarrhythmic drugs were stopped a minimum of 5 days before the procedure.…”