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Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Occurrence of atrial tachycardias (ATs) following radiofrequency (RF) pulmonary vein (PV) isolation for the treatment of paroxysmal atrial fibrillation (PAF) is a frequent complication. Cryoballoon (CB) ablation might create more homogeneous and demarcated lesions than traditional point by point RF approach, hypothetically leading to a lower incidence of ATs. Our aim is to compare incidence and mechanism of regular ATs occurring after ablation of PAF by means of circumferential point by point RF vs CB ablation.

Methods

Two hundred eighty-six consecutive patients undergoing a first PV isolation procedure, as treatment for PAF, were included and followed up for 12 months. Point by point RF ablation was performed in 186 patients and CB ablation in the remaining 100. Among the last ones, first generation (CB-1) was used in 59 patients and second generation one (CB-2) in 41.

Results

Incidence of regular ATs was higher following RF PV isolation when compared with CB ablation (11.3 vs 3.0 %, P = 0.028). When compared separately with RF ablation, both CB-1 and CB-2 presented lower incidences of ATs (5.1 and 0.0 %) but differences only remained significant for the CB-2 (P = 0.027).

Conclusion

Patients with PAF undergoing a first PV isolation procedure by means of CB ablation present a significantly lower incidence of ATs than those in which PV isolation is achieved by means of circumferential point by point RF ablation.

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Abbreviations

AF:

Atrial fibrillation

AT:

Atrial tachycardia

CB:

Cryoballoon

CMC:

Circular mapping catheter

CS:

Coronary sinus

CTI:

Cavotricuspid isthmus

ILMC:

Inner lumen mapping catheter

LA:

Left atrium

LMWH:

Low molecular weight heparin

OAC:

Oral anticoagulation

PAF:

Paroxysmal atrial fibrillation

PV:

Pulmonary vein

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

RF:

Radiofrequency

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Conflict of interest

GBC and CdA receive compensation for the proctoring and teaching purposes from AF Solutions Medtronic.

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Authors and Affiliations

  1. Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium

    Justo Juliá, Gian-Battista Chierchia, Carlo de Asmundis, Giacomo Mugnai, Juan Sieira, Giuseppe Ciconte, Giacomo Di Giovanni, Giulio Conte, Giannis Baltogiannis, Yukio Saitoh, Kristel Wauters, Ghazala Irfan & Pedro Brugada

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  1. Justo Juliá
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  2. Gian-Battista Chierchia
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  3. Carlo de Asmundis
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Correspondence to Justo Juliá.

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Juliá, J., Chierchia, GB., de Asmundis, C. et al. Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques. J Interv Card Electrophysiol 42, 161–169 (2015). https://doi.org/10.1007/s10840-014-9961-4

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  • DOI: https://doi.org/10.1007/s10840-014-9961-4

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