Key result
Second-generation cryoballoon ablation resulted in a significantly lower incidence of early pulmonary vein reconnection compared to phased radiofrequency (7% vs 18%; P<0.0001).
Why the study?
To compare the incidence of early conduction recurrence after PVI between phased radiofrequency using PVAC and cryo-ablation using a second-generation cryoballoon.
Does phased radiofrequency by a multipolar ablation catheter compared to second-generation cryoballoon affect the incidence of early pulmonary vein reconnection in patients with atrial fibrillation?
Cohort (n=200)
Does phased radiofrequency by a multipolar ablation catheter compared to second-generation cryoballoon affect the incidence of early pulmonary vein reconnection in patients with atrial fibrillation?
Second-generation cryoballoon ablation is associated with a significantly lower incidence of early pulmonary vein reconnection and shorter procedure times compared to phased radiofrequency with a multipolar ablation catheter.
Answers are grounded in this paper and cite their sources.
Cryoballoon was associated with fewer early reconnections; hypothesis-generating and leaves open need for RCTs on outcomes.
OBJECTIVE: To determine and compare the incidence of early recurrence of conduction after pulmonary vein isolation (PVI) using two different ablation technologies: phased radiofrequency by a multipolar ablation catheter (PVAC) and cryo-ablation by a second-generation cryoballoon (CB). METHODS AND RESULTS: Two hundred patients (pts) with atrial fibrillation underwent PVI with PVAC (Group 1) or CB (Group 2), with 100 pts in each group. The incidence of PV reconnection (PVR) for each vein was examined in both groups at least 30 minutes after successful PVI. There were no significant clinical differences between both groups. Total procedure-, fluoroscopy-, and left atrial (LA) dwell time were significantly shorter in Group 2 pts (P < .0001). Early PVR was recorded in 69/388 (18%) isolated PVs or left common trunks (CTs) in Group 1 compared with 25/386 (7%) in Group 2 (P < .0001). Forty-three pts in Group1 were found to have PVR compared with 22 pts in Group 2 (P = .0015). Group 1 pts with CTs showed significantly more PVR than pts of Group 2 (P = .047). In both groups, CTs and CT branches were found to reconnect significantly more frequent compared with all other veins. CONCLUSION: Both PVAC and CB are effective to achieve PVI. Early PVR is observed with the significantly lower frequency with second-generation CB compared with PVAC, contributing to shorter procedure-, fluoroscopy, and LA dwell times. CTs and CT branches exhibit the highest incidence of PVR for both devices.
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Wieczorek et al. (2019) conducted a cohort in Atrial fibrillation (n=200). Phased radiofrequency by a multipolar ablation catheter (PVAC) vs. Cryo-ablation by a second-generation cryoballoon (CB) was evaluated on Early pulmonary vein reconnection (PVR) per isolated vein or left common trunk (p=<.0001). Second-generation cryoballoon ablation resulted in a significantly lower incidence of early pulmonary vein reconnection compared to phased radiofrequency (7% vs 18%; P<0.0001).
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