Catheter ablation of atrial fibrillation : radiofrequency catheter ablation for redo procedures after cryoablation

• Published in: World Journal of Cardiology
• Main Authors: Kettering, Klaus, Gramley, Felix
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2013
• Subjects: ddc:610; Arctic
• Online Access: http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/32052; https://nbn-resolving.org/urn:nbn:de:hebis:30:3-320529; https://doi.org/10.4330/wjc.v5.i8.280; http://publikationen.ub.uni-frankfurt.de/files/32052/WJC-5-280.pdf

Aim: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation. Methods: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure. Results: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications. Conclusion: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.