A systematic approach of repeat procedures with a second-generation cryoballoon using a different balloon size than the index procedure resulted in 70% of patients being free of recurrent AF at 1 year.
Cohort (n=40)
No
Does a staged variable balloon size strategy with a second-generation cryoballoon prevent atrial fibrillation recurrence in patients with recurrent paroxysmal atrial fibrillation after an index cryoballoon procedure?
A staged variable balloon size strategy using a second-generation cryoballoon for redo ablation in recurrent paroxysmal atrial fibrillation is safe and achieves a 70% freedom from recurrence at 1 year.
PURPOSE: Currently, information on the optimal approach of redo procedures for paroxysmal atrial fibrillation (PAF) is limited. Radiofrequency ablation is the preferred technique, with reported success rates of 50-70% at 1-2 years, whereas only few reports exist on redo cryoballoon (CB) ablations. We describe outcomes on a systematic approach of repeat procedures with a second-generation cryoballoon (CB-2) after a successful index CB ablation. METHODS: -VASc score 1 (IQR 0-3). Per protocol, a staged variable balloon size strategy was followed with a different balloon size during the redo as compared to the index procedure. Minimal follow-up was 12 months (median 17 months IQR 14-39). RESULTS: Overall, 120 pulmonary veins (PVs) (75%) showed chronic isolation: 64% (41/64) for first-generation cryoballoon (CB-1) and 82% (79/96) for CB-2 index procedures, respectively (p = 0.01). The overall mean number of reconnected PVs per patient was 1.0 (40/40): 1.4 for CB-1 and 0.7 for CB-2 index procedures (p = 0.008). Phrenic nerve palsies (n = 7) resolved before the end of the procedure. At 1 year, 70% of patients were free of recurrent AF. In multivariate analysis, the only independent predictor of recurrence was the number of prior cardioversions. CONCLUSIONS: A systematic approach of repeat procedures with a CB-2 using a different balloon size than during the index CB ablation is safe, with acceptable 1-year outcomes. Future comparative studies on the optimal redo technique and approach are warranted to further improve rhythm control in AF.
Westra et al. (Wed,) conducted a cohort in Recurrent paroxysmal atrial fibrillation (n=40). Second-generation cryoballoon (CB-2) ablation with variable balloon size was evaluated on Freedom from atrial fibrillation recurrence at 12 months. A systematic approach of repeat procedures with a second-generation cryoballoon using a different balloon size than the index procedure resulted in 70% of patients being free of recurrent AF at 1 year.