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Pulmonary vein reconnection following catheter ablation of atrial fibrillation using the second-generation cryoballoon versus open-irrigated radiofrequency: results of a multicenter analysis

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Catheter ablation of atrial fibrillation (CAAF) using the cryoballoon has emerged as an alternate strategy to point-by-point radiofrequency. However, there is little comparative data on long-term durability of pulmonary vein (PV) isolation comparing these two modalities.

Methods

In this multicenter, retrospective analysis, the incidences/patterns of late PV reconnection following an index CAAF using the second-generation cryoballoon versus open-irrigated, non-force-sensing radiofrequency were examined.

Results

Of the 2002 patients who underwent a first-time CAAF, 186/1126 patients (16.5 %) ablated using cryoballoon and 174/876 patients (19.9 %) with non-contact force-guided radiofrequency required a repeat procedure at 11 ± 5 months. During follow-up, the incidence of atrial flutters/tachycardias was lower (19.9 vs. 32.8 %; p = 0.005) and fewer patients exhibited PV reconnection (47.3 vs. 60.9 %; p = 0.007) with cryoballoon versus radiofrequency. Additionally, fewer PVs had reconnected with cryoballoon versus radiofrequency (18.8 vs. 34.6 %; p < 0.001). With cryoballoon, the right inferior (p < 0.001) and left common (p = 0.039) PVs were more likely to exhibit late reconnection, versus the left superior PV with radiofrequency (p = 0.012). However, when comparing the two strategies, the left common PV was more likely to exhibit reconnection with cryoballoon, whereas all other PVs with the exception of the right inferior PV demonstrated a lower reconnection rate with cryoballoon versus radiofrequency. Lastly, in a logistic regression multivariate analysis, cryoballoon ablation and PV ablation time emerged as significant predictors of durable PV isolation at repeat procedure.

Conclusions

In this large multicenter, retrospective analysis, CAAF using the second-generation cryoballoon was associated with improved durability of PV isolation compared to open-irrigated, non-force-sensing radiofrequency.

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Authors and Affiliations

  1. Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA

    Arash Aryana, Mark R. Bowers & Padraig Gearoid O’Neill

  2. Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

    Sheldon M. Singh

  3. Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium

    Giacomo Mugnai, Carlo de Asmundis, Pedro Brugada & Gian-Battista Chierchia

  4. Staten Island Heart and North Shore-LIJ Health System, Staten Island, NY, USA

    Marcin Kowalski

  5. CHI Baylor St. Luke’s Medical Center, Texas Heart Institute, Houston, TX, USA

    Deep K. Pujara & Steve K. Singh

  6. Aurora Denver Cardiology Associates - Aurora, Aurora, CO, USA

    Andrew I. Cohen, Charles E. Fuenzalida & Nelson Prager

  7. Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Santa Catarina, Brazil

    André d’Avila

Authors
  1. Arash Aryana
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  2. Sheldon M. Singh
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  3. Giacomo Mugnai
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  13. Pedro Brugada
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  15. Gian-Battista Chierchia
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Correspondence to Arash Aryana.

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Conflicts of interest

Drs. Aryana, Brugada, Chierchia, de Asmundis, Kowalski, and O’Neill have received consulting fees and speaker honoraria and Drs. Aryana and O’Neill have received a research grant from Medtronic, Inc. Additionally, Drs. Aryana, Cohen, Fuenzalida, and d’Avila have received consulting fees and speaker honoraria, and Drs. Aryana and O’Neill have received research grants from Biosense Webster, Inc.

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Aryana, A., Singh, S.M., Mugnai, G. et al. Pulmonary vein reconnection following catheter ablation of atrial fibrillation using the second-generation cryoballoon versus open-irrigated radiofrequency: results of a multicenter analysis. J Interv Card Electrophysiol 47, 341–348 (2016). https://doi.org/10.1007/s10840-016-0172-z

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  • DOI: https://doi.org/10.1007/s10840-016-0172-z

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