Key result
An alternating ablation technique strategy for repeat ablation in patients with recurrent atrial fibrillation yielded similar two-year AF-free survival regardless of the sequence (73.3% for CB-RFC vs 71.9% for RFC-CB, p=0.873).
Why the study?
Pulmonary vein reconnection after radiofrequency ablation or second-generation cryoballoon pulmonary vein isolation is common.
Does an alternating redo ablation strategy (CB-RFC vs RFC-CB) yield different long-term AF-free outcomes in patients with recurrent atrial fibrillation after a failed index ablation?
Cohort (n=156)
No
Does an alternating redo ablation strategy (CB-RFC vs RFC-CB) yield different long-term AF-free outcomes in patients with recurrent atrial fibrillation after a failed index ablation?
Absolute Event Rate: 73.3% vs 71.9%
p-value: p=0.873
An alternating ablation strategy for recurrent atrial fibrillation (using cryoballoon after failed radiofrequency, or vice versa) yields similar and effective long-term AF-free outcomes regardless of the initial technique.
Alternating redo ablation strategies merit prospective evaluation; leaves open whether technique switching improves outcomes after failed PVI.
Background Pulmonary vein (PV) reconnection after radiofrequency ablation (RFC) or 2nd generation cryoballoon (CB) pulmonary vein isolation (PVI) is common. Method We report a single-center experience of 156 patients who underwent an alternating redo procedure-ablation strategy for recurrent atrial fibrillation (AF) after a failed index RFC or CB procedure. During the redo procedure, alternating ablation technique was applied in a reverse sequence: RFC was applied for redo ablation in 60 patients with failed index CB ablation(CB-RFC-redo); 2nd generation CB was used for redo ablation in 96 patients after failed index RFC ablation (RFC-CB redo); Results During the redo procedure, the proportion of patients with PV reconnection was lower after index CB PVI procedure compared with the proportion of patients after index RFC PVI (88.3% versus 98.9%, p = 0.01). Additionally, 82.8% of all PVs and left common trunks PV (CTs) isolated by index RFC were reconnected, compared with 42% PVs reconnected after index CB PVI (p = 0.005). A mean number of 1.50 ± 0.8 PVs /patient were reconnected after index CB PVI, compared with 3.36 ± 0.9 PVs /patient after index RFC PVI (p = 0.001). Patients after index RFC PVI frequently presented with ≥ 3 reconnected PVs, compared with index CB PVI(70.8% vs 10%, p < 0.001). A total of 60 patients after index CB PVI underwent RFC-redo ablation, and 96 patients after index RFC PVI underwent CB-redo ablation. At a two year follow-up, 43 patients (27.6%) developed recurrence after redo ablation, with a similar AF- free outcome (CB-RFC redo:73.3% vs RFC-CB redo: 71.9%, p = 0.873). In the multivariate analysis, persistent AF (HR = 2.107, 95% CI: 1.085–4.091, p = 0.028) and early AF recurrence after the initial ablation (HR = 2.431, 95% CI: 1.279–4.618, p = 0.007) were independent predictors of AF recurrence after repeat ablation. Conclusions The extent and distribution of PV reconnections were different after index RFC and CB PVI procedures. Alternating CB or RFC ablation technique strategy is effective with a similar long-term outcome, and it may be an appropriate option for repeated AF ablation regardless of index ablation technique used.
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Tang et al. (2022) conducted a cohort in Recurrent atrial fibrillation (n=156). Alternating redo ablation strategy (CB-RFC redo) vs. RFC-CB redo was evaluated on Atrial fibrillation-free outcome at two years (p=0.873). An alternating ablation technique strategy for repeat ablation in patients with recurrent atrial fibrillation yielded similar two-year AF-free survival regardless of the sequence (73.3% for CB-RFC vs 71.9% for RFC-CB, p=0.873).
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