Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation

Roberto Verlato; Paolo Pieragnoli; Saverio Iacopino; Werner Rauhe; Giulio Molon; Giuseppe Stabile; Luca Rebellato; Giuseppe Allocca; Giuseppe Arena; Giovanni Rovaris; Riccardo Sacchi; Domenico Catanzariti; Patrizia Pepi; Claudio Tondo

doi:10.1111/pace.13975

June 8, 2020Pacing and Clinical Electrophysiology

Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation

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Why the study?

It remained unclear which ablation technique is superior for repeat procedures in patients with atrial fibrillation.

Does radiofrequency repeat ablation after failed cryoballoon ablation reduce atrial fibrillation recurrence compared to cryoballoon repeat ablation after failed radiofrequency ablation in patients with atrial fibrillation?

Structured PICO

Does radiofrequency repeat ablation after failed cryoballoon ablation reduce atrial fibrillation recurrence compared to cryoballoon repeat ablation after failed radiofrequency ablation in patients with atrial fibrillation?

P

Population

474 consecutive patients with atrial fibrillation undergoing a first repeat ablation procedure after a failed index pulmonary vein isolation, from the 1STOP Italian Project.

I

Intervention

Radiofrequency (RF) repeat ablation following a failed cryoballoon (CB) index ablation (CB-then-RF group, n=125)

C

Comparator

Cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation with radiofrequency (RF) ablation (RF-then-CB group, n=349)

O

Outcome

Atrial fibrillation (AF) recurrence at long-term follow-up

Implication

In patients undergoing repeat ablation for atrial fibrillation, using radiofrequency after a failed cryoballoon procedure is associated with significantly less long-term AF recurrence than using cryoballoon after a failed radiofrequency procedure.

Abstract

BACKGROUND: Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. METHODS: Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. RESULTS: We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P < .001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. CONCLUSION: Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.