Klaus Kettering1, Felix Gramley2. 1. Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. Klaus.Kettering@t-online.de. 2. HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany.
Abstract
BACKGROUND: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). Cryoablation has been shown to be a safe and effective technique for pulmonary vein (PV) isolation. However, the arrhythmia recurrence rate is high after cryoablation procedures. Radiofrequency catheter ablation has been shown to be an effective strategy for redo procedures in these patients and to provide a favourable outcome during midterm follow-up. The aim of this study was to analyse whether the strategy also provides favourable results during long-term follow-up (5 years). METHODS: In this study 30 patients (paroxysmal AF: 22 patients, persistent AF: 8 patients) underwent a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (Arctic Front Balloon, Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster, Diamond Bar, CA, USA) depending on the intraprocedural findings. RESULTS: During the repeat procedure, a mean number of 2.9 reconnected PV (SD ± 1.0) were detected. In 20 patients, a segmental approach was sufficient to eliminate the residual PV conduction because only a few PV fibres were recovered (1-3 reconnected PV; group A). In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the pulmonary vein - left atrial (PV-LA) conduction (group B). All reconnected PV were isolated successfully again. A third or fourth ablation procedure had to be performed in 4 (3 and 1, respectively) patients (13.3%). At 5‑year follow-up, 66.7% of all patients were free from an arrhythmia recurrence (20 out of 30). There were no major complications during long-term follow-up. CONCLUSION: In patients with an initial circumferential PV isolation using the cryoballoon technique, a repeat ablation procedure can be safely and effectively performed using radiofrequency catheter ablation providing good long-term follow-up results.
BACKGROUND: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). Cryoablation has been shown to be a safe and effective technique for pulmonary vein (PV) isolation. However, the arrhythmia recurrence rate is high after cryoablation procedures. Radiofrequency catheter ablation has been shown to be an effective strategy for redo procedures in these patients and to provide a favourable outcome during midterm follow-up. The aim of this study was to analyse whether the strategy also provides favourable results during long-term follow-up (5 years). METHODS: In this study 30 patients (paroxysmal AF: 22 patients, persistent AF: 8 patients) underwent a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (Arctic Front Balloon, Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster, Diamond Bar, CA, USA) depending on the intraprocedural findings. RESULTS: During the repeat procedure, a mean number of 2.9 reconnected PV (SD ± 1.0) were detected. In 20 patients, a segmental approach was sufficient to eliminate the residual PV conduction because only a few PV fibres were recovered (1-3 reconnected PV; group A). In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the pulmonary vein - left atrial (PV-LA) conduction (group B). All reconnected PV were isolated successfully again. A third or fourth ablation procedure had to be performed in 4 (3 and 1, respectively) patients (13.3%). At 5‑year follow-up, 66.7% of all patients were free from an arrhythmia recurrence (20 out of 30). There were no major complications during long-term follow-up. CONCLUSION: In patients with an initial circumferential PV isolation using the cryoballoon technique, a repeat ablation procedure can be safely and effectively performed using radiofrequency catheter ablation providing good long-term follow-up results.
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; Jose Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: J Interv Card Electrophysiol Date: 2012-03 Impact factor: 1.900
Authors: S Ernst; M Schlüter; F Ouyang; A Khanedani; R Cappato; J Hebe; M Volkmer; M Antz; K H Kuck Journal: Circulation Date: 1999-11-16 Impact factor: 29.690
Authors: Martin Schmidt; Uwe Dorwarth; Florian Straube; Michael Wankerl; Jürgen Krieg; Alexander W Leber; Hans Ullrich Ebersberger; Marcos Daccarett; Armin Huber; Ernst Rummeny; Ellen Hoffmann Journal: Clin Res Cardiol Date: 2012-04-09 Impact factor: 5.460
Authors: Hakan Oral; Bradley P Knight; Mehmet Ozaydin; Aman Chugh; Steve W K Lai; Christoph Scharf; Sohail Hassan; Radmira Greenstein; Jihn D Han; Frank Pelosi; S Adam Strickberger; Fred Morady Journal: Circulation Date: 2002-09-03 Impact factor: 29.690
Authors: Thomas Neumann; Jürgen Vogt; Burghard Schumacher; Anja Dorszewski; Malte Kuniss; Hans Neuser; Klaus Kurzidim; Alexander Berkowitsch; Marcus Koller; Johannes Heintze; Ursula Scholz; Ulrike Wetzel; Michael A E Schneider; Dieter Horstkotte; Christian W Hamm; Heinz-Friedrich Pitschner Journal: J Am Coll Cardiol Date: 2008-07-22 Impact factor: 24.094