The importance of extrapulmonary vein triggers and atypical atrial flutter in atrial fibrillation recurrence after cryoablation: Insights from repeat ablation procedures

Chang, Ting‐Yung; Lo, Li‐Wei; Lin, Yenn‐Jiang; Chang, Shih‐Lin; Hu, Yu‐Feng; Chung, Fa‐Po; Chao, Tze‐Fan; Liao, Jo‐Nan; Tuan, Ta‐Chuan; Lin, Chin‐Yu; Vicera, Jennifer Jeanne B.; Huang, Ting-Chun; Hoang, Minh Quang; Yamada, Shuichi; Chen, Shih‐Ann

doi:10.1111/jce.13741

Cited by 22 publications

(17 citation statements)

References 28 publications

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“…21 It should be noted that in terms of the repeated atrial arrhythmia type, the majority of AF cases (96%) were identified by RFA in patients with persistent AF with PVI only, 22 whereas a higher rate of atrial flutter (54.4%) was found with CBA. 23 Studies on repeat ablation identified that extra -PV triggers (63.6%) were predominant in PVI with CBA, 23 while the proportion of PV reconnection via RFA reached a striking 80% and stability of contact in linear ablation with cryoballoon remain problematic. With respect to the safety profile, the risk of procedural and vascular access complications was comparable in CBA and RFA.…”

Section: What's New?mentioning

confidence: 99%

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Liu¹,

Gao²,

Jin³

et al. 2020

Kardiol Pol

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BACKGROUND Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging. AIMS This meta-analysis aimed to compare cryoballoon ablation (CBA) with radiofrequency ablation (RFA) for persistent AF. METHODS A systematic search of the PubMed, EMBASE, and Cochrane Library databases was performed for studies comparing the outcomes between CBA and RFA. Seven trials including 934 patients were analyzed. RESULTS There were no differences between groups in terms of freedom from atrial arrhythmia (risk ratio [RR], 1.04; 95% CI, 0.93-1.15; P = 0.52; I 2 = 0%), procedural complications (RR, 0.91; 95% CI, 0.52-1.59; P = 0.74; I 2 = 0%), atrial fibrillation or atrial tachycardia relapse during the blanking period (RR, 0.73; 95% CI, 0.50-1.06; P = 0.1; I 2 = 9%), repeat ablation (RR, 0.74; 95% CI, 0.45-1.21; P = 0.23; I 2 = 62%), and vascular complications (RR, 0.98; 95% CI, 0.42-2.27; P = 0.97; I 2 = 0%). Cryoballoon ablation increased the incidence of conversion to sinus rhythm during ablation (RR, 1.69; 95% CI, 1.01-2.83; P = 0.046; I 2 = 0%) and phrenic nerve palsy (PNP; RR, 3.05; 95% CI, 0.95-9.8; P = 0.06; I 2 = 0%), while RFA increased the risk of cardiac tamponade (RR, 0.27; 95% CI, 0.06-1.25; P = 0.09; I 2 = 0%). Subanalyses revealed a lower incidence of recurrent atrial arrhythmia and repeat ablation during CBA without touch-up RFA in pulmonary vein isolation. CONCLUSIONS CBA provides an alternative technique for persistent AF ablation. It might reduce the risk of repeat ablation and cardiac tamponade but increase the risk of PNP.

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Section: What's New?mentioning

confidence: 99%

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Liu¹,

Gao²,

Jin³

et al. 2020

Kardiol Pol

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“…[ 31 – 36 ] Chang et al reported that in the second procedure, higher LA flutter occurred in the CBA group than in the RFCA group (54.5% versus 12.5%). [ 37 ] The possible explanation is that CBA produced more extensive low LA voltage areas than RFCA, which might have contributed to LA macroreentrant ATs. [ 37 ] Of all the LA macroreentrant ATs in CBA, perimitral flutter (45.5%) is the most common type, followed by roof flutter (27.3%) and septal flutter (9%).…”

Section: Incidencementioning

confidence: 99%

“…[ 37 ] The possible explanation is that CBA produced more extensive low LA voltage areas than RFCA, which might have contributed to LA macroreentrant ATs. [ 37 ] Of all the LA macroreentrant ATs in CBA, perimitral flutter (45.5%) is the most common type, followed by roof flutter (27.3%) and septal flutter (9%).…”

Section: Incidencementioning

confidence: 99%

Atrial Tachycardias After Atrial Fibrillation Ablation: How to Manage?

Hung

Chang

Wang

et al. 2020

Arrhythm Electrophysiol Rev

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With catheter ablation becoming effective for non-pharmacological management of AF, many cases of atrial tachycardia (AT) after AF ablation have been reported in the past decade. These arrhythmias are often symptomatic and respond poorly to medical therapy. Post-AF-ablation ATs can be classified into the following three categories: focal, macroreentrant and microreentrant ATs. Mapping these ATs is challenging because of atrial remodelling and its complex mechanisms, such as double ATs and multiple-loop ATs. High-density mapping can achieve precise identification of the circuits and critical isthmuses of ATs and improve the efficacy of catheter ablation. The purpose of this article is to review the mechanisms, mapping and ablation strategy, and outcome of ATs after AF ablation.

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“…Pulmonary veins isolation (PVI) forms the cornerstone of catheter ablation for atrial fibrillation (AFib). 1 Often PVI is followed by linear applications when atrial flutter (AFL) is registered. 2 Resumption of AFib often occurs due to reconnection of PVs with the left atrium (LA) and becomes a substrate for the development of other atrial arrhythmias, such as atypical AFL.…”

Section: Introductionmentioning

confidence: 99%

High‐density mapping of multiple atypical atrial flutter. First HD GRID mapping experience among The Commonwealth of Independent States

Bakytzhanuly¹,

Abdrakhmanov²,

Seisembekov

et al. 2020

Journal of Arrhythmia

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Mapping of multiple atrial tachycardias after previous cryoballoon pulmonary vein isolations and multiple radiofrequency ablations can be challenging even for experienced specialists. HD Grid high‐density mapping catheter is one of the catheters, which helps not only to precisely identify the mechanisms of macro‐reentry tachycardia but also to avoid unnecessary radiofrequency applications. Accordingly, we present two cases of complex atrial arrhythmia with the use of HD Grid, which showed clear visualization of mechanisms and target ablations with the termination of tachycardia.

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The importance of extrapulmonary vein triggers and atypical atrial flutter in atrial fibrillation recurrence after cryoablation: Insights from repeat ablation procedures

Abstract: There was no difference in AF recurrence after catheter ablation between CBA and RFCA, but significant increases of non-PV triggers and LA flutter during the second procedure suggest the importance of the atrial substrate in maintaining AF during the second procedure after previous CBA.

Cited by 22 publications

References 28 publications

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Atrial Tachycardias After Atrial Fibrillation Ablation: How to Manage?

High‐density mapping of multiple atypical atrial flutter. First HD GRID mapping experience among The Commonwealth of Independent States

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