Correlation of pulmonary vein reconnection patterns after cryoballoon and duty‐cycled ablation of atrial fibrillation with the time of arrhythmia recurrence

Abstract Background Pulmonary vein isolation (PVI) is safe and effective in the treatment of atrial fibrillation (AF). We compare and correlate pulmonary vein (PV) reconnection patterns at repeat ablation in patients with recurrent AF after PVI using duty‐cycled radiofrequency (RF) technology (PVAC) or second‐generation cryoballoon (CB) with the time of AF recurrence. Methods and Results In total, 85 PVAC and 66 CB patients undergoing a second ablation were enrolled 9.7 ± 3.4 months after initial PVI. PV reconnections were comparably high between both groups (93% PVAC and 92% CB patients). A mean of 2.79 ± 1.2 PVs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, P  < .0001. 33% PVAC patients, but no CB patient had 4 reconnected PVs ( P  < .0001). Early AF recurrences were more frequently observed in PVAC patients with ≥2 reconnected PVs, in CB patients with ≥3 reconnected PVs (both P  < .01) and patients without PV reconnection, irrespective of the ablation technique. One reconnected PV was associated with late AF recurrence only in CB patients. The correlation between number of reconnected PVs and time of AF recurrence was −0.32 for PVAC and −0.52 for CB. Conclusions CB PVI was associated with greater durability and lesser PV reconnections/patient. There were negative correlations for both devices between extent of PV reconnections and time of AF recurrence. CB patients with early AF recurrences‐ although less frequently observed compared with PVAC patients had more reconnected PVs than PVAC patients, suggesting additional effects for AF prevention after CB PVI.