Second-generation cryoballoon ablation yielded a similar rate of ATP-provoked dormant pulmonary vein conduction compared to contact force-based radiofrequency ablation (4% vs 6%, P=0.3935).
Cohort (n=112)
Single-blind
None
No
Does second-generation cryoballoon ablation improve lesion characteristics and unexcitable tissue width compared to contact force-based radiofrequency ablation in patients with atrial fibrillation?
Second-generation cryoballoon ablation creates significantly wider unexcitable ablation zones than contact force-guided RF ablation, likely due to extensive PV distension, which may explain its durability.
Absolute Event Rate: 4% vs 6%
p-value: p=0.3935
BACKGROUND: The mechanism explaining the efficacy of cryoballoon ablation (CBA) for atrial fibrillation has not been clarified. METHODS AND RESULTS: We compared lesion characteristics between patients in whom pulmonary vein isolation (PVI) was performed by CBA (n=56) and those by contact force (CF)-based RF ablation (n=56). We evaluated the 3-dimensional PV morphology before and after cryoballoon inflation. After PVI, a 3D left atrial voltage map was created. Pacing (10 mA and 2 ms) was performed within the low voltage area from the ablation line, and electrically unexcitable ablated tissue was identified. ATP-provoked dormant conduction after PVI occurred in 9 of the 224 (4%) PVs in the CBA group and in 13 of the 224 (6%) PVs in the CF group (P=0.3935). The inflated balloon stretched the PV from the original PV ostial surface by 7.1±3.5 mm, but at sites with (vs, sites without) residual PV potential/dormant conduction, the extent of the PV distension was reduced (4.0±4.0 mm vs. 7.2±3.4 mm, P<0.0001). The unexcitable ablated tissue around the PVs was significantly wider in CB patients than in CF patients (16.7±5.1 mm vs. 5.3±2.3 mm, P<0.0001). CONCLUSIONS: Use of the cryoballoon significantly distends the PV. Without this extensive distention, PVI may not be successful. CBA seems to yield wide unexcitable ablation zones. These factors seem to explain the durability of CBA lesions.
Okumura et al. (Sun,) conducted a cohort in Atrial fibrillation (n=112). Second-generation cryoballoon ablation vs. Contact force-based radiofrequency ablation was evaluated on ATP-provoked dormant conduction per pulmonary vein (p=0.3935). Second-generation cryoballoon ablation yielded a similar rate of ATP-provoked dormant pulmonary vein conduction compared to contact force-based radiofrequency ablation (4% vs 6%, P=0.3935).