Key result
Cryoballoon re-ablation after failed RF links to ~131% higher AFib recurrence than RF after failed cryoballoon.
Why the study?
AF recurrence after circumferential PV isolation is common, but the optimal ablation technique for repeat ablation in recurrent AF remains unclear.
Does an alternate energy source sequence (RFC-CB vs CB-RFC) affect atrial fibrillation recurrence rates in patients undergoing repeat ablation?
Case-Control (n=156)
No
Does an alternate energy source sequence (RFC-CB vs CB-RFC) affect atrial fibrillation recurrence rates in patients undergoing repeat ablation?
Effect estimate: HR 2.314 (95% CI 1.128-4.747)
Absolute Event Rate: 31.3% vs 16.7%
p-value: p=0.022
In patients with recurrent atrial fibrillation, repeat ablation using radiofrequency energy after a failed cryoballoon ablation resulted in significantly less AF recurrence compared to cryoballoon ablation after a failed radiofrequency ablation.
May favor radiofrequency re-ablation after cryoballoon failure; hypothesis-generating for energy sequence in redo AF ablation.
Background: Atrial fibrillation recurrence after circumferential pulmonary vein (PV) isolation was common. Which ablation technique is better for repeat ablation in patients with recurrent atrial fibrillation (AF) remains unclear. We aimed to investigate long-term efficacy of repeat ablation using a novel alternately energy source sequence for re-ablation of patients with recurrent atrial fibrillation: cryoballoon (CB) re-ablation for patients with a failed radiofrequency (RFC) ablation (RFC-CB redo group); radiofrequency energy re- ablation for patients with a failed cryoballoon ablation (CB-RFC redo group). Method: Recurrent AF patients received a repeat ablation procedure in our hospital were enrolled into the study. Demographic and re-ablation procedural characteristics and outcomes were compared among groups. Results: A total of 156 patients were enrolled into the study, 60 patients (38.5%) were in the CB-RFC-redo group and 96 patients (61.5%) were in the RFC-CB-redo group. Longer duration of AF (69.31±64.69 vs 50.78 ±51.48 months; P=0.039) and longer time from first ablation to re-ablation (54.02 ±38.10 vs 14.2 ±10.5 months; P=0.001) were observed in the RFC-CB-redo group as compared with the CB-RFC redo group. Early recurrence rates of atrial fibrillation following initial ablation were equal among groups (RFC-CB-redo group: 42.7% vs CB-RFC-redo group:48.3% , p=0.515).The number of reconnected PVs was significantly higher in the RFC-CB redo group than the CB-RFC redo group (3.36 ± 0.96 vs 1.50 ± 0.81, p=0.01). During the average follow-up of 10.7 ±2.41 months, significantly less AF recurrence was observed in the CB-RFC redo group (16.7% vs 31.3%, p=0.045). In the multivariate analysis, different energy ablation sequence, AF type and early recurrence after the initial ablation were independent predictors of AF recurrence after re-ablation. Conclusions: Alternate energy source sequence strategy for re-ablation of patients with recurrent atrial fibrillation was safe and moderately effective. However, Large multi-center studies must be warranted to provide conclusive evidence.
No takes yet. Share an insight, caveat, or question.
Tang et al. (2021) conducted a case-control in Recurrent Atrial Fibrillation (n=156). Cryoballoon re-ablation (RFC-CB redo) vs. Radiofrequency re-ablation (CB-RFC redo) was evaluated on Atrial fibrillation recurrence (HR 2.314, 95% CI 1.128-4.747, p=0.022). Cryoballoon re-ablation after failed radiofrequency ablation increased atrial fibrillation recurrence risk compared to radiofrequency re-ablation after failed cryoballoon ablation (HR 2.314).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: