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Peinado, Rafael PeinadoAutor o Coautor

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

Publicado en:Cardiology Journal. 31 (2): 193-204 - 2024-04-26 31(2), DOI: 10.5603/CJ.a2023.0017

Autores: Alvarez-Ortega, Carlos Antonio; Guillen, Cesar Rainer Solorzano; Cordero, Alberto Barrera; Ramos, Jorge Enrique Toquero; Martinez-Alday, Jesus Daniel; Morales, Carlos Eugenio Grande; Gonzalez, Anibal Rodriguez; Garcia-Alberola, Arcadio; Alvarez, Luisa Perez; Osorio, Angel Ferrero De Loma; Afosno, Julio Salvador Hernandez; Leon, Rocio Cozar; Perez, Oscar Cano; Trucco, Emilce; Peinado, Rafael Peinado

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Background: Ablation of atrial fibrillation (AF), both cryoballoon 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 hazard ratio 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. (Cardiol J )

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