Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Aug 26, 2013; 5(8): 280-287
Published online Aug 26, 2013. doi: 10.4330/wjc.v5.i8.280
Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation
Klaus Kettering, Felix Gramley
Klaus Kettering, Felix Gramley, Department of Cardiology, University of Frankfurt, 60590 Frankfurt, Germany
Author contributions: Both authors have contributed significantly to this manuscript. They have made substantial contributions to the design of the study, to the acquisition of data and to the interpretation of the results. They have revised the manuscript critically for its scientific content. Both authors have approved the final version of the manuscript.
Correspondence to: Klaus Kettering, MD, Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. klaus.kettering@t-online.de
Telephone: +49-69-63017273 Fax: +49-69-63016457
Received: February 25, 2013
Revised: June 20, 2013
Accepted: July 18, 2013
Published online: August 26, 2013
Processing time: 192 Days and 10.4 Hours
Abstract

AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.

METHODS: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure.

RESULTS: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications.

CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.

Keywords: Atrial fibrillation, Catheter ablation, Cryoablation, Pulmonary veins, Supraventricular arrhythmias

Core tip: Cryoablation has been shown to be a safe technique for pulmonary vein isolation. However, the arrhythmia recurrence rate is high. Therefore, we have summarized our initial experience with two different strategies for redo procedures using radiofrequency catheter ablation. Thirty patients had to undergo a redo procedure after initially successful circumferential pulmonary vein isolation with the cryoballoon technique. The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy depending on the intra-procedural findings. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence.