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A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Pulmonary vein (PV) reconnection after radiofrequency (RFC) or cryoballoon (CB) pulmonary vein isolation (PVI) is common.

Method

We report a single-center experience of 156 patients who underwent a redo procedure-ablation strategy for recurrent atrial fibrillation (AF) in a reverse sequence after a failed index RFC or CB PVI.

Results

A total of 60 patients after index CB PVI underwent RFC-redo ablation (CB-RFC redo), and 96 patients after index RFC PVI underwent CB-redo ablation (RFC-CB redo). 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, 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). At a 2-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.

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.

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Abbreviations

AF:

Atrial fibrillation

LA:

Left atrial

LVEF:

Left ventricular ejection fraction

LAD:

Left atrial diameter

RFC:

Radiofrequency catheter ablation

CB:

Cryoballoon

HR:

Hazard ratio

PV:

Pulmonary vein

CTs:

Left common trunk(s)

LAA:

Left atrial appendage

LSPV(s):

Left superior pulmonary vein(s)

LIPV(s):

Left inferior pulmonary vein(s)

RSPV(s):

Right superior pulmonary vein(s)

RIPV(s):

Right inferior pulmonary vein(s)

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Funding

This study was supported by the National Natural Science Foundation of China (No.81670309).

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Authors and Affiliations

  1. Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Road, Xicheng District, Beijing, China

    Qing-hui Tang, Xiao-Gang Guo & Jian Ma

Authors
  1. Qing-hui Tang
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  2. Xiao-Gang Guo
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  3. Jian Ma
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Corresponding author

Correspondence to Jian Ma.

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Compliance with ethical standards

The retrospective study was approved by the Ethics Committee of the Fuwai Hospital (No. 2016–829) according to the Helsinki Declaration.

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Written informed consent was provided by all participants or their legal guardians. All methods were performed in accordance with the relevant guidelines and regulations of the Declaration of Helsinki.

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The authors declare no competing interests.

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Tang, Qh., Guo, XG. & Ma, J. A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience. J Interv Card Electrophysiol 65, 739–750 (2022). https://doi.org/10.1007/s10840-022-01321-x

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