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Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?
Affiliations- Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
- Hospital Universitario Vírgen de la Victoria, Málaga, Spain
- Hospital Universitario Puerta de Hierro, Majadahonda, Spain
- Hospital Universitario De Basurto, Bilbao, Spain
- Clínica Zorrotzaure, Bilbao, Spain
- Hospital Universitario Son Espases, Mallorca, Spain
- Hospital Universitario De Canarias, Tenerife, Spain
- Hospital Universitario Vírgen de la Arrixaca, Murcia, Spain
- Complejo Hospitalario Universitario de Coruña, Spain
- Hospital Universitario Clínico de Valencia, Spain
- Hospital Quirón Valencia, Spain
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
- Hospital Universitario Vírgen Macarena, Sevilla, Spain
- Hospital Vithas Sevilla, Spain
- Hospital Universitario La Fé, Valencia, Spain
- Hospital Universitario Josep Trueta, Girona, Spain
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Abstract
Background: Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA. Methods: A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built. Results: Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4–75.8%) in the Prior-CB, and 89.2% (95% CI 73.6–95.9%) in the Prior-RF group (p = 0.002). Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05–6.79). Conclusions: Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991.
Abstract
Background: Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA. Methods: A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built. Results: Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4–75.8%) in the Prior-CB, and 89.2% (95% CI 73.6–95.9%) in the Prior-RF group (p = 0.002). Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05–6.79). Conclusions: Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991.
Keywords
cryoablation, atrial fibrillation, catheter ablation, radiofrequency catheter ablation
About this articleTitle
Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?
Journal
Issue
Article type
Original Article
Published online
2023-03-10
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142
Article views/downloads
69
DOI
10.5603/CJ.a2023.0017
Pubmed
Keywords
cryoablation
atrial fibrillation
catheter ablation
radiofrequency catheter ablation
Authors
Carlos Antonio Álvarez-Ortega
César Rainer Solórzano Guillén
Alberto Barrera Cordero
Jorge Enrique Toquero Ramos
Jesús Daniel Martínez-Alday
Carlos Eugenio Grande Morales
Aníbal Rodríguez González
Arcadio García Alberola
Luisa Pérez Álvarez
Ángel Ferrero de Loma Osorio
Julio Salvador Hernández Afonso
Rocío Cózar León
Óscar Cano Pérez
Emilce Trucco
Rafael Peinado Peinado
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