Long-term outcome of cryoballoon ablation versus radiofrequency ablation for focal atrial tachycardias originating from the pulmonary veins

  • Hui-Qiang Wei
  • Xiao-Gang Guo
  • Gong-Bu Zhou
  • Qi Sun
  • Xu Liu
  • Bin Luo
  • Jian-Du Yang
  • Shu Zhang
  • Jian MaEmail author



We aimed to investigate the characteristics of focal atrial tachycardias (ATs) arising from the pulmonary veins (PVs), as well as the safety and long-term efficacy of cryoballoon (CB) versus radiofrequency (RF) ablation in this population.


Eighty-three patients with ATs arising from PVs from a consecutive series of 487 patients who underwent CB and RF ablation were retrospectively reviewed. Patients who had a prior history of atrial fibrillation (AF) were excluded. The AT origin was confirmed during the conventional electrophysiological study and activation mapping. The ablation approach was at the discretion of the operators.


Thirty-five patients were managed with focal ablation, 25 were ablated with unilateral PV isolation (PVI), and the remaining 23 were performed with CB ablation. All procedures were successfully ablated. There was no significant difference in procedure time between CB group and RF focal group (43.7 ± 11.8 min vs. 45.8 ± 11.2 min, P = 0.121), whereas the fluoroscopy time in CB group was longer than in RF PVI group (10.1 ± 2.5 min vs. 8.4 ± 2.8 min, P < 0.001). There was 1 recurrence in CB group, 4 recurrences of AT in RF focal group, and 2 recurrence in RF PVI group (P = 0.643). Repeat ablation was performed in 6 of 7 patients. Seventy-eight patients were available for long-term follow-up. At a mean of 5.4 ± 4.6-year follow-up, 77 of 78 patients were free from AT without antiarrhythmic medication after 1.1 ± 0.3 procedures. No patient had procedural complications and developed AF during the follow-up period.


CB ablation is an effective and safe tool to treat ATs originating from the PVs. The ATs originating from the PVs represent an isolated clinical process and are not likely to be the forerunner of a more diffuse process leading to the development of PV AF.


Focal atrial tachycardia Pulmonary vein Cryoballoon Radiofrequency ablation Atrial fibrillation 



This work was funded by a grant of the National Natural Science Foundation of China (#81670309).

Compliance with ethical standards

The research protocol used in this study was reviewed and approved by the institutional review board of the Fuwai Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kalman JM, Olgin JE, Karch MR, et al. “Cristal tachycardias”: origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. J Am Coll Cardiol. 1998;31:451–9.CrossRefGoogle Scholar
  2. 2.
    Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol. 2006;48:1010–7.CrossRefGoogle Scholar
  3. 3.
    Chen SA, Tai CT, Chiang CE, et al. Focal atrial tachycardia: reanalysis of the clinical and electrophysiologic characteristics and prediction of successful radiofrequency ablation. J Cardiovasc Electrophysiol. 1998;9:355–65.CrossRefGoogle Scholar
  4. 4.
    Kistler PM, Sanders P, Fynn SP, et al. Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: acute and long-term outcomes of radiofrequency ablation. Circulation. 2003;108:1968–75.CrossRefGoogle Scholar
  5. 5.
    Baranowski B, Wazni O, Lindsay B, et al. Focal ablation versus single vein isolation for atrial tachycardia originating from a pulmonary vein. Pacing Clin Electrophysiol. 2010;33:776–83.CrossRefGoogle Scholar
  6. 6.
    Teh AW, Kalman JM, Medi C, et al. Long-term outcome following successful catheter ablation of atrial tachycardia originating from the pulmonary veins: absence of late atrial fibrillation. J Cardiovasc Electrophysiol. 2010;21:747–50.CrossRefGoogle Scholar
  7. 7.
    Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374:2235–45.CrossRefGoogle Scholar
  8. 8.
    Jensen-Urstad M, Bastani H, Braunschweig F, et al. Cryoballoon ablation: a novel technique for treating focal atrial tachycardias from the pulmonary veins. Europace. 2009;11:1445–7.CrossRefGoogle Scholar
  9. 9.
    Saoudi N, Cosio F, Waldo A, et al. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22:1162–82.CrossRefGoogle Scholar
  10. 10.
    Kistler PM, Sanders P, Hussin A, et al. Focal atrial tachycardia arising from the mitral annulus: electrocardiographic and electrophysiologic characterization. J Am Coll Cardiol. 2003;41:2212–9.CrossRefGoogle Scholar
  11. 11.
    Tada H, Kaseno K, Kubota S, et al. Swallowing-induced atrial tachyarrhythmias: prevalence, characteristics, and the results of the radiofrequency catheter ablation. Pacing Clin Electrophysiol. 2007;30:1224–32.CrossRefGoogle Scholar
  12. 12.
    Tang CW, Scheinman MM, Van Hare GF, et al. Use of P wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol. 1995;26:1315–24.CrossRefGoogle Scholar
  13. 13.
    Yamane T, Shah DC, Peng JT, et al. Morphological characteristics of P waves during selective pulmonary vein pacing. J Am Coll Cardiol. 2001;38:1505–10.CrossRefGoogle Scholar
  14. 14.
    Oral H, Ozaydin M, Tada H, et al. Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2002;13:645–50.CrossRefGoogle Scholar
  15. 15.
    Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.CrossRefGoogle Scholar
  16. 16.
    Khoueiry Z, Albenque JP, Providencia R, et al. Outcomes after cryoablation vs. radiofrequency in patients with paroxysmal atrial fibrillation: impact of pulmonary veins anatomy. Europace. 2016;18:1343–51.CrossRefGoogle Scholar
  17. 17.
    Cardoso R, Mendirichaga R, Fernandes G, et al. Cryoballoon versus radiofrequency catheter ablation in atrial fibrillation: a meta-analysis. J Cardiovasc Electrophysiol. 2016;27:1151–9.CrossRefGoogle Scholar
  18. 18.
    Avitall B, Urboniene D, Rozmus G, et al. New cryotechnology for electrical isolation of the pulmonary veins. J Cardiovasc Electrophysiol. 2003;14:281–6.CrossRefGoogle Scholar
  19. 19.
    Gaita F, Leclercq JF, Schumacher B, et al. Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon. J Cardiovasc Electrophysiol. 2011;22:961–8.CrossRefGoogle Scholar
  20. 20.
    Kenigsberg DN, Martin N, Lim HW, et al. Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon. Heart Rhythm. 2015;12:283–90.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hui-Qiang Wei
    • 1
  • Xiao-Gang Guo
    • 1
  • Gong-Bu Zhou
    • 2
  • Qi Sun
    • 1
  • Xu Liu
    • 3
  • Bin Luo
    • 1
  • Jian-Du Yang
    • 1
  • Shu Zhang
    • 1
  • Jian Ma
    • 1
    Email author
  1. 1.State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeFuwai HospitalBeijingChina
  2. 2.Department of cardiologyPeking University Third HospitalBeijingChina
  3. 3.Department of CardiologyBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina

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