INTRODUCTION: Several studies have revealed that second-generation cryoballoon (CB)-based pulmonary vein (PV) isolation is noninferior to radiofrequency (RF)-based PV isolation for patients with drug-refractory paroxysmal atrial fibrillation (AF). However, electrophysiological differences in repeat ablation remain unclear. METHODS AND RESULTS: This study examined electrophysiological differences during the repeat ablation between patients who first underwent RF catheter ablation and CB ablation; PV durability and non-PV AF foci were assessed for these patients. We enrolled 919 and 491 patients who underwent CB ablation (CB group) and RF catheter ablation (RF group), respectively, for paroxysmal AF between January 2013 and June 2017 at our institution. PV isolation using RF ablation involved the left atrium (LA) antrum and part of the LA posterior wall. After 2 years of follow-up, 62 and 80 patients in the CB and RF groups, respectively, underwent repeat ablation. PV reconnections were more frequent in the RF group than in the CB group (left superior PV: 46.2% and 14.5%, P < .001; left inferior PV: 35.0% and 11.2%, P = .001; right superior PV: 40.0% and 22.6%, P = .031; right inferior PV: 36.2% and 19.4%, P = .039; PVs: 39.8% and 16.9%, P < .001). LA AF foci were more frequent in the CB group than in the RF group (27.4% and 7.5%; P = .002). Other non-PV foci were prevalent in both groups. CONCLUSION: Fewer LA-PV reconnections occurred with CB ablation. However, extensive PV isolation may eliminate many LA AF foci.
INTRODUCTION: Several studies have revealed that second-generation cryoballoon (CB)-based pulmonary vein (PV) isolation is noninferior to radiofrequency (RF)-based PV isolation for patients with drug-refractory paroxysmal atrial fibrillation (AF). However, electrophysiological differences in repeat ablation remain unclear. METHODS AND RESULTS: This study examined electrophysiological differences during the repeat ablation between patients who first underwent RF catheter ablation and CB ablation; PV durability and non-PV AF foci were assessed for these patients. We enrolled 919 and 491 patients who underwent CB ablation (CB group) and RF catheter ablation (RF group), respectively, for paroxysmal AF between January 2013 and June 2017 at our institution. PV isolation using RF ablation involved the left atrium (LA) antrum and part of the LA posterior wall. After 2 years of follow-up, 62 and 80 patients in the CB and RF groups, respectively, underwent repeat ablation. PV reconnections were more frequent in the RF group than in the CB group (left superior PV: 46.2% and 14.5%, P < .001; left inferior PV: 35.0% and 11.2%, P = .001; right superior PV: 40.0% and 22.6%, P = .031; right inferior PV: 36.2% and 19.4%, P = .039; PVs: 39.8% and 16.9%, P < .001). LA AF foci were more frequent in the CB group than in the RF group (27.4% and 7.5%; P = .002). Other non-PV foci were prevalent in both groups. CONCLUSION: Fewer LA-PV reconnections occurred with CB ablation. However, extensive PV isolation may eliminate many LA AF foci.