Key result
Prior radiofrequency ablation was associated with significantly more reconnected veins (3.00 vs 1.88; P<0.001) and gaps (4.84 vs 2.16; P<0.001) compared to prior cryoballoon ablation.
Why the study?
Are there differences in scar lesion formation and conduction gaps between previous radiofrequency and cryoballoon ablation in patients with AF recurrence?
Observational (n=50)
Yes
Are there differences in scar lesion formation and conduction gaps between previous radiofrequency and cryoballoon ablation in patients with AF recurrence?
Absolute Event Rate: 3% vs 1.88%
p-value: p=<0.001
High-density mapping reveals that conduction gaps after RF ablation are more numerous and smaller, whereas gaps after cryoballoon ablation are fewer but wider.
Distinct gap patterns after RF versus CB ablation may inform redo mapping; hypothesis-generating for lesion durability differences.
AIMS: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is usually associated to conduction gaps in pulmonary veins (PVs). Our objective was to characterize gaps in patients with recurrences after a first radiofrequency (RF) or cryoballoon (CB) PVI procedure, using a high-density mapping (HDM) system. METHODS AND RESULTS: Fifty patients with AF recurrence after a first PVI procedure (pre-RF 25 patients; pre-CB 25 patients) were included at two centres. Activation map (AM) and voltage map (VM) of the left atrium and PVs were built using the HDM Rhythmia® system. Superior PVs were reconnected more frequently in both groups. Right PVs were reconnected more frequently in pre-RF patients. Pre-RF patients had more reconnected veins than pre-CB patients (mean ± standard deviation: 3.00 ± 0.96 vs. 1.88 ± 1.13; P < 0.001) and more gaps (4.84 ± 2.06 vs. 2.16 ± 1.49; P < 0.001). Gaps in the VM were wider in pre-CB patients (16.5 ± 9.5 mm vs. 12.1 ± 4.8 mm; P = 0.006). There was a gap in 179 of the 800 PV segments analysed (22%); 52% were identified in both AM and VM maps; 39% only in the AM and 8% only in the VM. The highest sensitivity and specificity for gap detection was obtained with VM in pre-CB patients and with AM in pre-RF patients. CONCLUSION: In conclusion, HDM seems to be a useful and precise tool to detect conduction gaps after a first PVI procedure. The anatomical pattern and location of gaps depends on the technique used previously, usually being multiple, smaller, and better detected by AM after RF, and fewer, wider, and better detected by VM after CB.
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Ruiz‐Granell et al. (2018) conducted an observational in Atrial fibrillation recurrence after pulmonary vein isolation (n=50). Radiofrequency ablation vs. Cryoballoon ablation was evaluated on Number of reconnected veins (p=<0.001). Prior radiofrequency ablation was associated with significantly more reconnected veins (3.00 vs 1.88; P<0.001) and gaps (4.84 vs 2.16; P<0.001) compared to prior cryoballoon ablation.
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