Why the study?
Pulmonary vein reconnection is the main cause of AF recurrence after ablation, but electrophysiological findings in patients with permanent pulmonary vein isolation undergoing repeat procedures after cryoballoon ablation remained to be analysed.
Does the presence of durable pulmonary vein isolation compared to pulmonary vein reconnection affect electrophysiological findings and recurrence rates in patients undergoing redo ablation for recurrent arrhythmias after index cryoballoon ablation?
Does the presence of durable pulmonary vein isolation compared to pulmonary vein reconnection affect electrophysiological findings and recurrence rates in patients undergoing redo ablation for recurrent arrhythmias after index cryoballoon ablation?
In patients with recurrent arrhythmias after cryoballoon ablation, those with durable pulmonary vein isolation have more non-pulmonary vein foci and atrial flutters, but similar success rates after redo ablation compared to those with pulmonary vein reconnection.
AIMS: The main cause of atrial fibrillation recurrence after catheter ablation is pulmonary vein reconnection. The purpose of this retrospective study was to analyse the electophysiological findings in patients undergoing repeat procedures after an index cryoballoon ablation (CB-A) and presenting with permanency of pulmonary vein isolation (PVI) in all veins. In addition, we sought to compare the latter with a similar group of patients with reconnected veins at the redo procedure. METHODS: A total of 132 patients (81 men, 60.7 ± 12.4 years) who underwent CB-A for paroxysmal atrial fibrillation (PAF) were enrolled. Indication for the redo procedure was symptomatic PAF in 83 (63%), persistent atrial fibrillation (PerAF) in 32 (24%) or persistent regular atrial tachycardia (RAT) in 17 (13%) patients. RESULTS: Seventy-five (57%) patients presented a pulmonary vein reconnection (pulmonary vein group) during the redo procedure, whereas 57 (43%) had no pulmonary vein reconnection (non-pulmonary vein group). The non-pulmonary vein group exhibited significantly more non-pulmonary vein foci and atrial flutters than the pulmonary vein group after induction protocol (51 vs. 24%, P = 0.002 and 67 vs. 36%, P = 0.003, respectively). Twenty-two (29.3%) patients of the pulmonary vein group and 20 (35%) patients of the non-pulmonary vein group had atrial fibrillation/RAT recurrence after a mean follow-up of 12.5 ± 8 months. The survival analysis demonstrated no statistical significance in recurrence between both groups (log rank P = 0.358). CONCLUSION: Atrial fibrillation/RAT recurrence in patients after CB-A with durable PVI is significantly associated with non-pulmonary vein foci and atrial flutters. No statistically different success rate regarding atrial fibrillation/RAT freedom was detected between the pulmonary vein and non-pulmonary vein groups after redoing RF-CA.
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Varnavas et al. (2020) studied this question.
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