title: Pulmonary vein reconnection following catheter ablation of atrial fibrillation using the second-generation cryoballoon versus open-irrigated radiofrequency: results of a multicenter analysis.
abstract: OBJECTIVE
  Catheter ablation of atrial fibrillation (CAAF) using the cryoballoon has emerged as an alternate strategy to point-by-point radiofrequency. However, there is little comparative data on long-term durability of pulmonary vein (PV) isolation comparing these two modalities.
  
  
  METHODS
  In this multicenter, retrospective analysis, the incidences/patterns of late PV reconnection following an index CAAF using the second-generation cryoballoon versus open-irrigated, non-force-sensing radiofrequency were examined.
  
  
  RESULTS
  Of the 2002 patients who underwent a first-time CAAF, 186/1126 patients (16.5 %) ablated using cryoballoon and 174/876 patients (19.9 %) with non-contact force-guided radiofrequency required a repeat procedure at 11 ± 5 months. During follow-up, the incidence of atrial flutters/tachycardias was lower (19.9 vs. 32.8 %; p = 0.005) and fewer patients exhibited PV reconnection (47.3 vs. 60.9 %; p = 0.007) with cryoballoon versus radiofrequency. Additionally, fewer PVs had reconnected with cryoballoon versus radiofrequency (18.8 vs. 34.6 %; p < 0.001). With cryoballoon, the right inferior (p < 0.001) and left common (p = 0.039) PVs were more likely to exhibit late reconnection, versus the left superior PV with radiofrequency (p = 0.012). However, when comparing the two strategies, the left common PV was more likely to exhibit reconnection with cryoballoon, whereas all other PVs with the exception of the right inferior PV demonstrated a lower reconnection rate with cryoballoon versus radiofrequency. Lastly, in a logistic regression multivariate analysis, cryoballoon ablation and PV ablation time emerged as significant predictors of durable PV isolation at repeat procedure.
  
  
  CONCLUSIONS
  In this large multicenter, retrospective analysis, CAAF using the second-generation cryoballoon was associated with improved durability of PV isolation compared to open-irrigated, non-force-sensing radiofrequency.
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA. a_aryana@outlook.com.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
authors.affiliation: Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Staten Island Heart and North Shore-LIJ Health System, Staten Island, NY, USA.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.affiliation: CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX, USA.
authors.forename: Deep K
authors.initials: DK
authors.lastname: Pujara
authors.affiliation: Aurora Denver Cardiology Associates - Aurora, Aurora, CO, USA.
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Cohen
authors.affiliation: CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX, USA.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Aurora Denver Cardiology Associates - Aurora, Aurora, CO, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Fuenzalida
authors.affiliation: Aurora Denver Cardiology Associates - Aurora, Aurora, CO, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Prager
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Bowers
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
authors.forename: Padraig Gearoid
authors.initials: PG
authors.lastname: O'Neill
authors.affiliation: Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Santa Catarina, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: d'Avila
authors.affiliation: Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000706:statistics & numerical data; D003452:Cryosurgery / Q000295:instrumentation* / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D015994:Incidence; D038622:Internationality; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000706:statistics & numerical data*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Cryoballoon; Pulmonary vein reconnection; Radiofrequency