Durability of pulmonary vein isolation after radiofrequency-balloon ablation

Abstract

Abstract Aims Recently a multi-electrode radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) was introduced. To the best of our knowledge no data on PVI durability has yet been published. Objectives The aim of this single-center study was to investigate the incidence of pulmonary vein (PV) reconnectionafter RFB-guided PVI. Methods Patients undergoing second ablation for recurrent atrial tachyarrhythmia (ATa) following the initial RFB-PVI were investigated. Left arial (LA) electroanatomic mapping was used. The rate of PV reconnection, the type of recurrent ATaand procedural data were analyzed. Results Among 178 patients treated with RFB, 21 patients underwent a second procedure 11 ± 6 months after the initial PVI. 67% of these patients presented with atrial fibrillation (AF), 33% with atrial tachycardia. Regarding baseline characteristics, 71% of these patients were male, mean age was 67±10, mean BMI was 28±5, 67% had hypertension and 33% had coronary artery disease. Overall, 83 PVs including one left common PV (LCPV) were assessed. The rate of PV reconnection was 28% (23/83 PVs). 57% of patients (12/21) had at least one reconnected PV. Patient with PV-reconnection had more AF recurrence and less often atrial tachycardia (AT) (AF: 75%, AT: 25%) than patients with durably isolated PVs (AF: 56%, AT: 44%). Most reconnections were detected in septal PVs. Reconnections were distributed as follows: RIPV: 8/21, RSPV: 7/21, LIPV: 5/20, LSVP: 3/20, LCPV: 0/1. Precise localization of the gaps could be identified in 15/23 PVs. Most common gap locations were at the anterior carina (4/15) for septal PVs and anterior-inferior (3/15) at the LIPV. Ablation strategy was pure PV reisolation in 8/12 patients and PV reisolation with additional linear lesions in 4/12 patients. All patients with durably isolated PVs were treated with additional substrate modification. In total, following additional lesions were set: anterior line: 6, roof line: 11, cavotricuspid isthmus (CTI): 7, LAA-Isolation: 1, free wall of the right atrium: 1. Regarding procedural data of the index procedure, the number of applications was not a statistically significant predictor of reconnection (p=0.77). Conclusion We provide the first insight into durability of PVI after radiofrequency-balloon ablation. 72% of all PVs were still isolated. Our data on gap localization might help to identify regions where optimal balloon contact is difficult to achieve. More data on this topic might reveal predictors for PV reconnections.