title: Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation.
abstract: Comparative data of early recurrence rates of atrial fibrillation (ERAF) following second-generation cryoballoon (CB-G2) and radiofrequency current (RFC) ablation for pulmonary vein isolation (PVI) in paroxysmal AF (PAF) are rare. We randomized PAF patients into either PVI with CB-G2 (group 1) or PVI with a combined RFC-approach applying contact force (CF) with the endpoint of unexcitability (group 2) to investigate ERAF.
  
  
  
  In group 1 (n = 30), CB-G2-PVI was performed. After CF-PVI in group 2 (n = 30), bipolar pacing on the ablation line and additional ablation until unexcitability was conducted. Follow-up included 48 h of in-hospital monitoring followed by 5-day Holter ECGs 1, 2, 3, 6, 12 months postablation to evaluate ERAF. Acute PVI was reached in 100% of group 2 and in 99% of group 1. Shorter procedure durations (98.0 ± 21.9 vs. 114.3 ± 18.7 min, P < 0.05) but extended fluoroscopy times (15.4 ± 3.9 vs. 10.0 ± 4.3 min, P < 0.05) were found in the CB-G2 group. Ten non-severe complications occurred (6 vs. 4 in group 1 and 2, P = 0.73). In group 2, five patients suffered from ERAF vs. seven patients in group 1 (P = 0.67). The time until the occurrence of ERAF was shorter in group 2 (1 day (q1-q3: 1-4.5)) when compared with group 1 (22 (q1-q3: 6-54) days, P = 0.025).
  
  
  
  ERAF rates were equal among groups; however, they occurred earlier in the initial phase after RFC ablation when compared with CB-G2. PVI utilizing cryoablation is associated with shorter procedure durations but extended fluoroscopy time while being similarly secure.
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Gunawardene
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schaeffer
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Da-Un
authors.initials: DU
authors.lastname: Chung
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Moser
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Ruken Oezge
authors.initials: RO
authors.lastname: Akbulak
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Jularic
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Eickholt
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Nuehrich
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation*; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D005858:Germany; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010865:Pilot Projects; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D015641:Radiography, Interventional; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation catheter ablation; Contact force; Cryoballoon; Early recurrences; Paroxysmal atrial fibrillation; Radiofrequency