Localization of gaps during redo ablations of paroxysmal atrial fibrillation: Preferential patterns depending on the choice of cryoballoon ablation or radiofrequency ablation for the initial procedure.
BACKGROUND
Pulmonary vein (PV) isolation, using cryoballoon or radiofrequency ablation, is the cornerstone therapy for symptomatic paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. One-third of the patients have recurrences, mainly due to PV reconnections.


OBJECTIVE
To describe the different locations of reconnection sites in patients who had previously undergone radiofrequency or cryoballoon ablation, and to compare the characteristics of the redo procedures in both instances.


METHODS
Demographic data and characteristics of the initial ablation (cryoballoon or radiofrequency) were collected. Number and localization of reconduction gaps, and redo characteristics were reviewed.


RESULTS
Seventy-four patients scheduled for a redo ablation of paroxysmal AF were included; 38 had been treated by radiofrequency ablation and 36 by cryoballoon ablation during the first procedure. For the initial ablation, procedural and fluoroscopy times were significantly shorter for cryoballoon ablation (147.8±52.6min vs. 226.6±64.3min [P<0.001] and 37.0±17.7min vs. 50.8±22.7min [P=0.005], respectively). Overall, an identical number of gaps was found during redo procedures of cryoballoon and radiofrequency ablations. However, a significantly higher number of gaps were located in the right superior PV for patients first ablated with radiofrequency (0.9±1.0 vs. 0.5±0.9; P=0.009). Gap localization displayed different patterns. Although not significant, redo procedures of cryoballoon ablation were slightly shorter and needed shorter durations of radiofrequency to achieve PV isolation.


CONCLUSIONS
During redo procedures, gap localization pattern is different for patients first ablated with cryoballoon or radiofrequency ablation, and right superior PV reconnections occur more frequently after radiofrequency ablation. Redo ablation of a previous cryoballoon ablation appears to be easier.
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France. Electronic address: vincent.galand35@gmail.com.
Vincent
V
Galand
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Dominique
D
Pavin
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Nathalie
N
Behar
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Vincent
V
Auffret
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Damien
D
Fénéon
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Albin
A
Behaghel
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Jean-Claude
JC
Daubert
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Philippe
P
Mabo
Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
Raphaël P
RP
Martins
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011667:Pulmonary Veins / Q000601:surgery; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Ablation; Atrial fibrillation; Cryoballoon ablation; Cryothérapie; Fibrillation atriale; Radiofrequency; Radiofréquence; Redo; Redux