Pulmonary vein reconnection and repeat ablation characteristics following cryoballoon‐compared to radiofrequency‐based pulmonary vein isolation

Abstract Background Despite advances in efficacy and safety of pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence after PVI remains common. PV‐reconnection is the main finding during repeat PVI procedures performed to treat recurrent AF. Objective To analyze pulmonary vein (PV) reconnection patterns during repeat ablation procedures in a large cohort of consecutive patients undergoing radio frequency or cryoballoon‐based PVI. Methods Retrospective analysis of PV‐reconnection patterns and analysis of re‐ablation strategies in consecutive index RF‐ and CB‐based PVI and their respective re‐ablation procedures during concomitant usage of both energy sources at a single high‐volume center in Germany. Results A total of 610 first (06/2015–10/2022) and 133 s (01/2016–11/2022) repeat ablation procedures after 363 (60%) RF‐ and 247 (40%) CB‐based index PVIs between 01/2015 and 12/2021 were analyzed. PV‐reconnection was found in 509/610 (83%) patients at first and 74/133 (56%) patients at second repeat procedure. 465 of 968 (48%) initially via CB isolated PVs were reconnected at first re‐ablation but 796 of 1422 initially RF‐isolated PV (56%) were reconnected (OR: 0.73 95% CI: 0.62–0.86; p < .001). This was driven by fewer reconnections of the left PVs (LSPV: OR: 0.60 95% CI: 0.42–0.86; p = .005 and LSPV: 0.67 0.47–0.95; p = .026). PV‐reconnection was more likely after longer, RF‐based index PVI and in older females. Repeat procedures were shorter after CB‐compared to after RF‐PVI. Conclusions Reconnection remains the most common reason for repeat AF ablation procedures after PVI. Our data suggest to preferentially use of the cryoballoon during index PVI, especially in older women.