Abstract 13127: Catheter Ablation of Atrial Fibrillation: Midterm Outcome of Radiofrequency Catheter Ablation for Redo Procedures After Pulmonary Vein Isolation With the Cryoballoon First Versus Second Generation Cryoballoon)

Abstract

Introduction: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory AF. Cryoablation has been shown to be a safe and effective technique for PV isolation. However, there is a significant arrhythmia recurrence rate after cryoablation procedures and there are no established strategies for redo procedures in these patients. Therefore, we have summarized our experience with radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique (ater procedures performed with the first or second generation cryoballoon). Hypothesis / Methods: Sixty patients had to undergo a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (Arctic Front Balloon, Medtronic: 30 patients (group A); Arctic Front Advance, Medtronic: 30 patients (group B)). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO) depending on the intra-procedural findings. Results: During the redo procedure, a mean number of 1.9 re-conducting PVs were detected (group A: 2.5 re-conducting PVs, group B: 1.3 re-conducting PVs). In 26 patients in group A, a segmental approach was sufficient to eliminate the residual PV conduction because there were only a few recovered PV fibers (1-3 reconnected PVs; group A1). In the remaining 4 patients in group A, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction of all four PVs (group A2). In group B, a segmental approach was sufficient in all patients because there was only a minor reconnection of 1-2 PVs. All recovered PVs could be isolated sucessfully again. At 6-month follow-up, 80.0 % of all patients were free from an arrhythmia recurrence (48/60 patients; group A: 23/30 patients (76.7 %), group B: 25/30 patients (83.3 %)). Conclusions: In patients with an initial circumferential PVI using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using RF catheter ablation. In most cases only a few re-conducting PV fibers were found and therefore, a segmental re-ablation approach seems to be sufficient in the majority of patients.