Vol 31, No 2 (2024)
Original Article
Published online: 2023-03-10

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Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

Carlos Antonio Álvarez-Ortega1, César Rainer Solórzano Guillén1, Alberto Barrera Cordero2, Jorge Enrique Toquero Ramos3, Jesús Daniel Martínez-Alday45, Carlos Eugenio Grande Morales6, Aníbal Rodríguez González7, Arcadio García Alberola8, Luisa Pérez Álvarez9, Ángel Ferrero de Loma Osorio1011, Julio Salvador Hernández Afonso12, Rocío Cózar León1314, Óscar Cano Pérez15, Emilce Trucco16, Rafael Peinado Peinado1
Pubmed: 36908163
Cardiol J 2024;31(2):193-204.

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.

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