Once Isolated, Always Isolated? Incidence and Characteristics of Pulmonary Vein Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation

Circulation. Arrhythmia and Electrophysiology
Christian-Hendrik HeegerAndreas Metzner

Abstract

The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St. George's hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful second-generation 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131-357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%...Continue Reading

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