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


RESULTS
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%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found (P=0.0002).


CONCLUSIONS
The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Christian-Hendrik
CH
Heeger
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Erik
E
Wissner
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Shibu
S
Mathew
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Sebastian
S
Deiss
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Christine
C
Lemes
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Andreas
A
Rillig
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Peter
P
Wohlmuth
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Bruno
B
Reissmann
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Roland Richard
RR
Tilz
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Feifan
F
Ouyang
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Karl-Heinz
KH
Kuck
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. AndreasMetzner1@web.de.
Andreas
A
Metzner
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000295:instrumentation*; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
atrial fibrillation; cryosurgery; pulmonary veins; recurrence; tachycardia, supraventricular