Recurrent atrial fibrillation after initial cryoballoon ablation: New perspectives for intensive ablation in right superior pulmonary vein ostium for atrial fibrillation

Chunying Jiang; Jun Zhang; Zhongyuan Ren; Rong Guo; Hailing Li; Shuang Li; Mengyun Zhu; Peng Jia; Kai Tang; Dongdong Zhao; Yawei Xu

doi:10.1016/j.cryobiol.2021.09.011

October 13, 2021CryobiologyOpen Access

Recurrent atrial fibrillation after initial cryoballoon ablation: New perspectives for intensive ablation in right superior pulmonary vein ostium for atrial fibrillation

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Why the study?

Little was known about pulmonary vein potential reconnection to the left atrium and the localization of gaps in initial lesion sets following cryoablation in patients with recurrent AF.

Structured PICO

P

Population

29 consecutive patients with recurrent atrial fibrillation (AF) undergoing repeat radiofrequency (RF) ablation after an initial cryoballoon (CB) ablation procedure.

I

Intervention

Electrophysiological mapping (using CARTO system) and repeat radiofrequency (RF) ablation

O

Outcome

Incidence and localization of pulmonary vein conduction gapssurrogate

Atrial fibrillation recurrence after initial cryoballoon ablation is significantly associated with conduction gaps in the anterior and inferior segments of the right superior pulmonary vein, suggesting that more intensive initial ablation in this region may improve durable isolation.

Implication

PV reconnection mapping after CB may guide redo RF lesions; leaves open optimal initial lesion durability strategies.

Abstract

A significant proportion of patients with recurrent atrial fibrillation (AF) require repeat radiofrequency (RF) ablation after cryoballoon (CB) ablation. However, little is known about the pulmonary vein (PV) potential reconnection to left atrium and localization of gaps in the initial lesion sets following cryoablation in patients with recurrent AF. The data of 29 consecutive patients with repeat RF ablation for recurrent AF were analyzed. During the second ablation procedures, PV foci of AF were explored in 116 PVs by the CARTO system. All patients had complete PV isolation from initial cryoablation procedure. The fluoroscopy duration, mean cryoablation time and mean cryoablation frequency were lowest for the right superior pulmonary vein (RSPV) (58.69 ± 9.18 s, 185.10 ± 49.25 s and 1.07 ± 0.26; p = 0.024, p = 0.042 and p = 0.032). A significantly higher incidence of conduction gaps per patient was found for the RSPVs compared to the other PVs (p < 0.05 or p < 0.01). For RSPVs, it seemed that gaps were predominantly located at the anterior segment (22 gaps) and inferior segment (22 gaps). RSPV reconnection was independently related to a lower risk of major adverse events after the second ablation during follow up in the study patients (HR 0.275, 95%CI 0.078-0.967, p = 0.044). AF recurrence in patients after cryoablation is significantly associated with conduction gaps in the anterior and inferior segments of RSPVs. Various ablation strategies of close touch of CB on anterior and inferior segments of RSPV ostium, more freezing time and frequency for RSPV may help achieving durable PV isolation during follow up.