Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation
- 8 June 2020
- journal article
- research article
- Published by Wiley in Pacing and Clinical Electrophysiology
- Vol. 43 (7), 687-697
- https://doi.org/10.1111/pace.13975
Abstract
Background Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long‐term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re‐ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF‐then‐CB group or (b) RF repeat ablation following a failed CB ablation, CB‐then‐RF group. Methods Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. Results We studied 474 patients, 349 in RF‐then‐CB and 125 in CB‐then‐RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF‐then‐CB cohort as compared with the CB‐then‐RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF‐then‐CB and CB‐then‐RF group, respectively (P < .001). During the follow‐up, significantly less AF recurrence occurred in the CB‐then‐RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24‐0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. Conclusion Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long‐term follow‐up as compared with those originally treated by RF ablation receiving a CB repeat ablation.Keywords
This publication has 33 references indexed in Scilit:
- Cryoballoon Ablation of Pulmonary Veins for Paroxysmal Atrial FibrillationJournal of the American College of Cardiology, 2013
- Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablationWorld Journal of Cardiology, 2013
- Cryoballoon Versus Radiofrequency for Pulmonary Vein Re‐Isolation After a Failed Initial Ablation Procedure in Patients with Paroxysmal Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2012
- Very Late Relapse of Atrial Fibrillation after Pulmonary Vein Isolation: Incidence and Results of Repeat AblationPacing and Clinical Electrophysiology, 2010
- Pericardial effusion in atrial fibrillation ablation: a comparison between cryoballoon and radiofrequency pulmonary vein isolationEP Europace, 2010
- Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veinsJournal of Interventional Cardiac Electrophysiology, 2009
- Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmusEP Europace, 2007
- Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: A randomized trial of the ostial versus the extraostial ablation strategyAmerican Heart Journal, 2006
- ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm SocietyJournal of the American College of Cardiology, 2006
- Recovered Pulmonary Vein Conduction as a Dominant Factor for Recurrent Atrial Tachyarrhythmias After Complete Circular Isolation of the Pulmonary VeinsCirculation, 2005