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Recurrence of paroxysmal atrial fibrillation after cryoisolation of the pulmonary veins. Is a “redo” procedure using the cryoballoon useful?

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Abstract

Background

Pulmonary vein (PV) isolation with the cryoballoon technique is an effective and safe method to treat patients with paroxysmal atrial fibrillation (AF). However, the optimal treatment strategy for patients with recurrences after this ablation is unclear.

Aims

The aim of this single centre study was to evaluate the efficacy and safety of a “redo” procedure using the cryoballoon in this patient cohort. The secondary study objectives were to determine the rate of reconduction for individual PVs of the patients undergoing “redo” ablation and potential predictors of persistent PV isolation (PVI).

Methods

Between April 2006 and September 2009, all patients with paroxysmal AF recurrences after cryoballoon ablation a “redo” ablation with the cryoballoon was offered. PV conduction was determined and cryoapplications were performed in all reconnected PVs. Every 3 months, 7-day Holter ECG, symptom-driven transtelephonic ECG recordings, and questionnaires were collected for 12 months.

Results

Forty-seven patients underwent “redo” cryoballoon ablation. In all these patients, at least one PV with reconduction was found. Recurrent conduction was documented in 63 % of the left superior PV, 56 % of the left inferior PV, 43 % of the right superior PV, and 56 % of the right inferior PV. In 28 of the 47 patients (60 %), no AF recurrence was detectable during the 12-month follow-up (after 3 months blanking period). Rate of severe complications was low and not significantly different from that of the initial ablations.

Conclusion

“Redo” ablation using cryoballoon technology may be an effective and safe method to treat patients with recurrence of paroxysmal AF after cryoballoon PVI.

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Correspondence to Anja Schade.

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Editorial Commentary

This manuscript by Schade represents unique observations in patients undergoing a “redo” cryoablation for PAF. The detailed observations demonstrate a high rate of reconnection in subjects who had AF recurrence after initial cryoablation. The data presented also supports a high rate of freedom of AF recurrence after performing repeat isolation. These observations strongly suggest that recurrent PAF after cryoballoon PVI is due predominantly to reconnection of the PVs. While there are multiple limitations to the study, as noted by the authors, the conclusion that reapplication of cryoballoon ablations to achieve PVI seems to be a safe and effective method to treat patients with PAF recurrence after first cryoballoon ablation is novel and supported by the data and analysis.

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Schade, A., Langbein, A., Spehl, S. et al. Recurrence of paroxysmal atrial fibrillation after cryoisolation of the pulmonary veins. Is a “redo” procedure using the cryoballoon useful?. J Interv Card Electrophysiol 36, 287–295 (2013). https://doi.org/10.1007/s10840-012-9725-y

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  • DOI: https://doi.org/10.1007/s10840-012-9725-y

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