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Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation
Author(s) -
Verlato Roberto,
Pieragnoli Paolo,
Iacopino Saverio,
Rauhe Werner,
Molon Giulio,
Stabile Giuseppe,
Rebellato Luca,
Allocca Giuseppe,
Arena Giuseppe,
Rovaris Giovanni,
Sacchi Riccardo,
Catanzariti Domenico,
Pepi Patrizia,
Tondo Claudio
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13975
Subject(s) - medicine , ablation , atrial fibrillation , pulmonary vein , cardiology , radiofrequency ablation , cohort , rf ablation , catheter ablation
Background Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long‐term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re‐ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF‐then‐CB group or (b) RF repeat ablation following a failed CB ablation, CB‐then‐RF group. Methods Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. Results We studied 474 patients, 349 in RF‐then‐CB and 125 in CB‐then‐RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF‐then‐CB cohort as compared with the CB‐then‐RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF‐then‐CB and CB‐then‐RF group, respectively ( P < .001). During the follow‐up, significantly less AF recurrence occurred in the CB‐then‐RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24‐0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. Conclusion Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long‐term follow‐up as compared with those originally treated by RF ablation receiving a CB repeat ablation.