title: Repeat procedures after second-generation cryoballoon ablation as an index procedure for persistent atrial fibrillation: one-year follow-up.
abstract: OBJECTIVE
  Data indicate that the second-generation cryoballoon (Arctic Front Advance, Medtronic, Minnesota, USA) could be effective for persistent atrial fibrillation. However, electrophysiological findings and the midterm clinical outcome of repeat procedures following second-generation cryoballoon ablation are lacking.
  
  
  METHODS
  Consecutive patients with drug-resistant persistent atrial fibrillation who underwent a repeat ablation due to arrhythmia recurrence following an index procedure with second-generation cryoballoon were retrospectively included in our analysis. A total of 24 patients were included. Twenty underwent repeat procedures because of atrial fibrillation or left atrial arrhythmias and four because of typical atrial flutter. Mean time to recurrence of atrial tachyarrhythmias was 6.6 ± 3 months. Mean redo procedural time was 122 ± 23 min.
  
  
  RESULTS
  At a mean follow-up of 11.8 ± 6.5 months, 15 patients (75 %) did not experience recurrence of atrial arrhythmias. Of the five patients (25 %) who had recurrence of atrial tachyarrhythmia, four presented with persistent atrial fibrillation and one with a mitral isthmus-dependent flutter. Of note is that the four patients with typical flutter were free from atrial tachycardia recurrence after the redo procedure. Two patients (9 %) underwent a third procedure. Mean time to recurrence of atrial arrhythmias from the repeat procedure was 9 ± 1 months.
  
  
  CONCLUSIONS
  Our findings show that repeat ablation procedures following a second-generation cryoballoon ablation for persistent atrial fibrillation result in 75 % of freedom from any atrial tachycardia at 12 months follow-up. Of the recurrences, 63 % were due to new onset of atrial fibrillation and 37 % to organized tachycardias.
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Hugo Enrique
authors: HE
authors: Coutiño
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Carlo
authors: C
authors: de Asmundis
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Giacomo
authors: G
authors: Mugnai
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Darragh
authors: D
authors: Moran
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Valentina
authors: V
authors: De Regibus
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Erwin
authors: E
authors: Ströker
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Ken
authors: K
authors: Takarada
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Diego
authors: D
authors: Ruggiero
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Rajin
authors: R
authors: Choudhury
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Stefan
authors: S
authors: Beckers
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Carla
authors: C
authors: Van Gompel
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Jan
authors: J
authors: Poelaert
authors: Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy.
authors: Saverio
authors: S
authors: Iacopino
authors: Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy.
authors: Pasquale
authors: P
authors: Filannino
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Pedro
authors: P
authors: Brugada
authors: Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium. chierchiagb@yahoo.com.
authors: Gian-Battista
authors: GB
authors: Chierchia
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D001530:Belgium / Q000453:epidemiology; D017115:Catheter Ablation / Q000295:instrumentation / Q000706:statistics & numerical data*; D003452:Cryosurgery / Q000295:instrumentation / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012086:Reoperation / Q000295:instrumentation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cryoballoon; Pulmonary vein isolation; Repeat procedures