Comparison of regular atrial tachycardia incidence after circumferential radiofrequency versus cryoballoon pulmonary vein isolation in real-life practice.
BACKGROUND
Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation (PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.


OBJECTIVE
To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).


METHODS
All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA-AT) based on invasive mapping procedure findings and ECG P-wave morphology.


RESULTS
The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow-up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA-AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow-up was 3.5%.


CONCLUSIONS
In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Finn
F
Akerström
Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Hamid
H
Bastani
Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Per
P
Insulander
Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Jonas
J
Schwieler
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Miguel A
MA
Arias
Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Mats
M
Jensen-Urstad
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000453:epidemiology* / Q000209:etiology*
atrial fibrillation; atrial flutter; atrial tachycardia; catheter ablation; cryoballoon; pulmonary vein isolation