What does this research mean for the field?

Although the overall rate of patients with pulmonary vein reconnection at redo ablation is similarly high after both phased radiofrequency and cryoballoon ablation, cryoballoon ablation results in significantly fewer reconnected veins per patient and more stable atrial lesions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 23, 2020Open Access

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Structured PICO

Does initial PVI with phased radiofrequency compared to cryoballoon affect the extent and distribution of pulmonary vein reconnections in patients with recurrent AF?

Population

151 patients with recurrent atrial fibrillation undergoing a second electrophysiology study (redo PVI) after an initially successful PVI, mean age 60, 63% male.

Intervention

Initial pulmonary vein isolation using multielectrode phased radiofrequency (PVAC).

Comparator

Initial pulmonary vein isolation using 2nd generation cryoballoon (CB).

Outcome

Pulmonary vein (PV) reconnection patterns (percentage of reconnected PVs and number of reconnected PVs per patient) at repeat ablation.surrogate

In patients with recurrent AF, initial PVI with 2nd generation cryoballoon resulted in fewer and less extensive pulmonary vein reconnections at redo ablation compared to phased radiofrequency.

Abstract

BACKGROUND: Pulmonary vein isolation (PVI) using phased radiofrequency (RF) energy has been shown to be effective in the treatment of atrial fibrillation (AF). METHODS: We characterize and compare pulmonary vein (PV) reconnection at repeat ablation in patients with AF after initially successful PVI using phased RF technology (PVAC) or 2nd generation cryoballoon (CB). Eighty five patients undergoing redo PVI using multielectrode PVAC phased RF catheter and 66 patients after CB PVI were enrolled 9.7 ± 3.4 months after the initial ablation procedure. RESULTS: The percentage of patients with PV reconnection(s) was comparably high between both groups (93% PVAC and 92% CB). However, 75% of all PVs and left common trunks (CTs) isolated with PVAC were reconnected, compared with 52% reconnections after CB PVI (p < 0.001). A mean of 2.79 ± 1.2 PVs and CTs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, p < 0.0001. No patients in the CB group had 4 reconnected PVs, while this pattern of reconnection was observed in 33% in the PVAC group (p < 0.0001). The percentage of patients in the PVAC group with ≥3 reconnected PVs was significantly higher compared with CB patients (56 patients (66%) vs. 17 patients (26%), p < 0.0001), while the percentage of patients with no PV reconnection was comparably low in PVAC and CB patients (7 and 8%, respectively). CTs were most frequently reconnected after PVAC PVI (94%) and left superior PVs after CB ablation (67%), respectively. CONCLUSIONS: The number of patients with recurrent AF and PV reconnection(s) at redo PVI was comparably high between both groups. However, the extent and distribution of PV reconnections was different in many aspects, indicating more stable atrial lesions after CB PVI compared with PVAC technology.

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