Cryoballoon or RF Ablation: For Repeat AFib Procedures, Which is Better?

A new study in Pacing and Clinical Electrophysiology highlights what it found to be the most preferable techniques for repeat ablation in patients with atrial fibrillation (AFib).

“The aim of the study was to compare long‐term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure cryoballoon (CB) re‐ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation (RF‐then‐CB group), RF repeat ablation following a failed CB ablation (CB‐then‐RF group),” the authors wrote.

The study included 474 consecutive patients undergoing repeat ablation from the 1STOP Italian Project who received treatment with a different technique from the index procedure. There were 249 patients in the RF-the-CB group and 125 in the CB-then-RF group. There were more women in the RF-then-CB group versus the CB-then-RF group (21% vs. 30%), as well as more persistent AFib (33% vs. 22%), a longer duration of AFib (60 months vs. 31 months), and more hypertension (50% vs. 36%).

According to the study results, the number of reconnected pulmonary veins was  3.7±0.7 in the RF-then-CB group compared with 1.4+1.3 in the CB-then-RF group (P<0.001). The authors reported significantly less AFib recurrence in the CB-then-Rf group (22% vs. 8%; HR=0.46; 95% CI, 0.24 to 0.92; P=0.025).The only identified independent predictor of AFib recurrence, according to the researchers, was cohort designation.

“Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first,” the authors wrote in their conclusion. “However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long‐term follow‐up as compared with those originally treated by RF ablation receiving a CB repeat ablation.”