TY - JOUR
T1 - Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation
AU - Verlato, Roberto
AU - Pieragnoli, Paolo
AU - Iacopino, Saverio
AU - Rauhe, Werner
AU - Molon, Giulio
AU - Stabile, Giuseppe
AU - Rebellato, Luca
AU - Allocca, Giuseppe
AU - Arena, Giuseppe
AU - Rovaris, Giovanni
AU - Sacchi, Riccardo
AU - Catanzariti, Domenico
AU - Pepi, Patrizia
AU - Tondo, Claudio
N1 - Funding Information:
The ClinicalService project is an international medical care quality improvement project. The technological infrastructure, comprising a clinical data repository and a framework for data management and statistical analysis, is managed by Medtronic. In each hospital participating in the project, physician or nurses are responsible to enter data in the clinical repository through a web-based data collection platform. An independent committee, composed by physicians participating in the project, prospectively identifies key clinical questions to be analyzed to improve therapy knowledge and patient care. A charter assigns the ownership of data to the participating centers and governs the conduct and relationship of the scientific committee and Medtronic. The first author of the manuscript had the ability to directly access the clinical dataset and to query any aspect of the data and to verify coherence between the data and the information described in the statistical report. The first author and the other coauthors have full responsibility in terms of integrity and interpretation of results and of manuscript development. Medtronic had no role in identifying research objectives, interpreting results, or drafting the manuscript. However, Medtronic verifies that the technical information related to the Medtronic devices described in the manuscript is correct. We would like to thank Hae Lim, an employee of Medtronic Inc., for his help in the preparation of the manuscript. Each author has contributed significantly to the submitted work. Roberto Verlato, Paolo Pieragnoli, Saverio Iacopino, Giovanni Rovaris, Claudio Tondo, Giuseppe Arena, and Giulio Molon contributed in the conception and design of the research project. Roberto Verlato, Saverio Iacopino, Claudio Tondo, and Paolo Pieragnoli interpreted data. All authors contributed in data acquisition. Roberto Verlato, Giuseppe Stabile, and Werner Rahue drafted the manuscript, and all authors revised it critically for important intellectual content.
Publisher Copyright:
© 2020 Wiley Periodicals LLC
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. Methods: Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. Results: We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P =.041), more persistent AF (33% vs 22%; P =.015), longer duration of AF (60 vs 31 months; P <.001), and more hypertension (50% vs 36%; P =.007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P <.001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P =.025). Cohort designation was the only independent predictor of AF recurrence. Conclusion: Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.
AB - Background: Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. Methods: Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. Results: We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P =.041), more persistent AF (33% vs 22%; P =.015), longer duration of AF (60 vs 31 months; P <.001), and more hypertension (50% vs 36%; P =.007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P <.001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P =.025). Cohort designation was the only independent predictor of AF recurrence. Conclusion: Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.
KW - AF recurrence
KW - atrial fibrillation
KW - cryoballoon ablation
KW - pulmonary vein isolation
KW - radiofrequency ablation
KW - repeat ablation
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U2 - 10.1111/pace.13975
DO - 10.1111/pace.13975
M3 - Article
C2 - 32510595
AN - SCOPUS:85087162071
VL - 43
SP - 687
EP - 697
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 7
ER -