Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques.

PURPOSE: Occurrence of atrial tachycardias (ATs) following radiofrequency (RF) pulmonary vein (PV) isolation for the treatment of paroxysmal atrial fibrillation (PAF) is a frequent complication. Cryoballoon (CB) ablation might create more homogeneous and demarcated lesions than traditional point by point RF approach, hypothetically leading to a lower incidence of ATs. Our aim is to compare incidence and mechanism of regular ATs occurring after ablation of PAF by means of circumferential point by point RF vs CB ablation.
METHODS: Two hundred eighty-six consecutive patients undergoing a first PV isolation procedure, as treatment for PAF, were included and followed up for 12 months. Point by point RF ablation was performed in 186 patients and CB ablation in the remaining 100. Among the last ones, first generation (CB-1) was used in 59 patients and second generation one (CB-2) in 41.
RESULTS: Incidence of regular ATs was higher following RF PV isolation when compared with CB ablation (11.3 vs 3.0%, P = 0.028). When compared separately with RF ablation, both CB-1 and CB-2 presented lower incidences of ATs (5.1 and 0.0%) but differences only remained significant for the CB-2 (P = 0.027).
CONCLUSION: Patients with PAF undergoing a first PV isolation procedure by means of CB ablation present a significantly lower incidence of ATs than those in which PV isolation is achieved by means of circumferential point by point RF ablation.