Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures

Marc D Lemoine; Julius Obergassel; Sandro Jaeckle; Moritz Nies; Sophia Taraba; Celine Mencke; Jan Rieß; Ilaria My; Laura Rottner; Fabian Moser; Djemail Ismaili; Bruno Reißmann; Feifan Ouyang; Paulus Kirchhof; Andreas Rillig; Andreas Metzner

doi:10.1093/europace/euae221

Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures

Marc D Lemoine^*, Julius Obergassel, Sandro Jaeckle, Moritz Nies, Sophia Taraba, Celine Mencke, Jan Rieß, Ilaria My, Laura Rottner, Fabian Moser, Djemail Ismaili, Bruno Reißmann, Feifan Ouyang, Paulus Kirchhof, Andreas Rillig, Andreas Metzner

^*Corresponding author for this work

Cardiovascular Sciences

Research output: Contribution to journal › Article › peer-review

6 Downloads (Pure)

Abstract

Aims: Pulsed-field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI). Initial data demonstrated high safety and efficacy. Data on long-term PVI durability and reconduction patterns in comparison to established energy sources for PVI are scarce. We compare findings in repeat ablation procedures after a first PFA to findings in repeat ablation procedures after a first cryoballoon ablation (CBA) based PVI.

Methods and result: A total of 550 consecutively enrolled patients underwent PFA or CBA index PVI. Repeat ablations in patients with symptomatic atrial arrhythmia recurrences were analysed. A total of 22/191 (12%) patients after index PFA-PVI and 44/359 (12%) after CBA-PVI underwent repeat ablation. Reconduction of any pulmonary vein (PV) was detected by multipolar spiral mapping catheter at each PV with careful evaluation of PV potentials and by 3D-mapping in 16/22 patients (73%) after PFA-PVI and in 33/44 (75%) after CBA-PVI (P = 1.000). Of 82 initially isolated PVs after PFA-PVI, 31 (38%) were reconducting; of 169 isolated PVs after CBA-PVI, 63 (37%) were reconducting (P = 0.936). Clinical atrial tachycardia occurred similarly in patients after PFA (5/22; 23%) and CBA (7/44; 16%; P = 0.515). Roof lines were set more often after PFA- (8/22; 36%) compared with CBA-PVI (5/44; 11%; P = 0.023). Repeat procedure duration [PFA: 87 (76, 123) min; CBA: 93 (75, 128) min; P = 0.446] was similar and fluoroscopy time [PFA: 11 (9, 14) min; CBA: 11 (8, 14) min; P = 0.739] equal between groups at repeat ablation.

Conclusion: During repeat ablation after previous PFA- or CBA-based PVI, electrical PV-reconduction rates and patterns were similar.

Original language	English
Article number	euae221
Journal	Europace
Volume	26
Issue number	9
Early online date	21 Aug 2024
DOIs	https://doi.org/10.1093/europace/euae221
Publication status	Published - Sept 2024

Keywords

Atrial fibrillation
Cryoballoon
Reisolation
Pulsed-field ablation
Pulmonary vein isolation
Reconduction
Repeat ablation
Atrial tachycardia

Access to Document

10.1093/europace/euae221Licence: Creative Commons: Attribution (CC BY)

LemoineMD2024Pulsed-fieldFinal published version, 254 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

Lemoine, M. D., Obergassel, J., Jaeckle, S., Nies, M., Taraba, S., Mencke, C., Rieß, J., My, I., Rottner, L., Moser, F., Ismaili, D., Reißmann, B., Ouyang, F., Kirchhof, P., Rillig, A., & Metzner, A. (2024). Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures. Europace, 26(9), Article euae221. https://doi.org/10.1093/europace/euae221

@article{23322e6f195a4430a82cbe351503503b,

title = "Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures",

abstract = "Aims: Pulsed-field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI). Initial data demonstrated high safety and efficacy. Data on long-term PVI durability and reconduction patterns in comparison to established energy sources for PVI are scarce. We compare findings in repeat ablation procedures after a first PFA to findings in repeat ablation procedures after a first cryoballoon ablation (CBA) based PVI. Methods and result: A total of 550 consecutively enrolled patients underwent PFA or CBA index PVI. Repeat ablations in patients with symptomatic atrial arrhythmia recurrences were analysed. A total of 22/191 (12%) patients after index PFA-PVI and 44/359 (12%) after CBA-PVI underwent repeat ablation. Reconduction of any pulmonary vein (PV) was detected by multipolar spiral mapping catheter at each PV with careful evaluation of PV potentials and by 3D-mapping in 16/22 patients (73%) after PFA-PVI and in 33/44 (75%) after CBA-PVI (P = 1.000). Of 82 initially isolated PVs after PFA-PVI, 31 (38%) were reconducting; of 169 isolated PVs after CBA-PVI, 63 (37%) were reconducting (P = 0.936). Clinical atrial tachycardia occurred similarly in patients after PFA (5/22; 23%) and CBA (7/44; 16%; P = 0.515). Roof lines were set more often after PFA- (8/22; 36%) compared with CBA-PVI (5/44; 11%; P = 0.023). Repeat procedure duration [PFA: 87 (76, 123) min; CBA: 93 (75, 128) min; P = 0.446] was similar and fluoroscopy time [PFA: 11 (9, 14) min; CBA: 11 (8, 14) min; P = 0.739] equal between groups at repeat ablation. Conclusion: During repeat ablation after previous PFA- or CBA-based PVI, electrical PV-reconduction rates and patterns were similar.",

keywords = "Atrial fibrillation, Cryoballoon, Reisolation, Pulsed-field ablation, Pulmonary vein isolation, Reconduction, Repeat ablation, Atrial tachycardia",

author = "Lemoine, {Marc D} and Julius Obergassel and Sandro Jaeckle and Moritz Nies and Sophia Taraba and Celine Mencke and Jan Rie{\ss} and Ilaria My and Laura Rottner and Fabian Moser and Djemail Ismaili and Bruno Rei{\ss}mann and Feifan Ouyang and Paulus Kirchhof and Andreas Rillig and Andreas Metzner",

year = "2024",

month = sep,

doi = "10.1093/europace/euae221",

language = "English",

volume = "26",

journal = "Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "9",

}

TY - JOUR

T1 - Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures

AU - Lemoine, Marc D

AU - Obergassel, Julius

AU - Jaeckle, Sandro

AU - Nies, Moritz

AU - Taraba, Sophia

AU - Mencke, Celine

AU - Rieß, Jan

AU - My, Ilaria

AU - Rottner, Laura

AU - Moser, Fabian

AU - Ismaili, Djemail

AU - Reißmann, Bruno

AU - Ouyang, Feifan

AU - Kirchhof, Paulus

AU - Rillig, Andreas

AU - Metzner, Andreas

PY - 2024/9

Y1 - 2024/9

N2 - Aims: Pulsed-field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI). Initial data demonstrated high safety and efficacy. Data on long-term PVI durability and reconduction patterns in comparison to established energy sources for PVI are scarce. We compare findings in repeat ablation procedures after a first PFA to findings in repeat ablation procedures after a first cryoballoon ablation (CBA) based PVI. Methods and result: A total of 550 consecutively enrolled patients underwent PFA or CBA index PVI. Repeat ablations in patients with symptomatic atrial arrhythmia recurrences were analysed. A total of 22/191 (12%) patients after index PFA-PVI and 44/359 (12%) after CBA-PVI underwent repeat ablation. Reconduction of any pulmonary vein (PV) was detected by multipolar spiral mapping catheter at each PV with careful evaluation of PV potentials and by 3D-mapping in 16/22 patients (73%) after PFA-PVI and in 33/44 (75%) after CBA-PVI (P = 1.000). Of 82 initially isolated PVs after PFA-PVI, 31 (38%) were reconducting; of 169 isolated PVs after CBA-PVI, 63 (37%) were reconducting (P = 0.936). Clinical atrial tachycardia occurred similarly in patients after PFA (5/22; 23%) and CBA (7/44; 16%; P = 0.515). Roof lines were set more often after PFA- (8/22; 36%) compared with CBA-PVI (5/44; 11%; P = 0.023). Repeat procedure duration [PFA: 87 (76, 123) min; CBA: 93 (75, 128) min; P = 0.446] was similar and fluoroscopy time [PFA: 11 (9, 14) min; CBA: 11 (8, 14) min; P = 0.739] equal between groups at repeat ablation. Conclusion: During repeat ablation after previous PFA- or CBA-based PVI, electrical PV-reconduction rates and patterns were similar.

AB - Aims: Pulsed-field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI). Initial data demonstrated high safety and efficacy. Data on long-term PVI durability and reconduction patterns in comparison to established energy sources for PVI are scarce. We compare findings in repeat ablation procedures after a first PFA to findings in repeat ablation procedures after a first cryoballoon ablation (CBA) based PVI. Methods and result: A total of 550 consecutively enrolled patients underwent PFA or CBA index PVI. Repeat ablations in patients with symptomatic atrial arrhythmia recurrences were analysed. A total of 22/191 (12%) patients after index PFA-PVI and 44/359 (12%) after CBA-PVI underwent repeat ablation. Reconduction of any pulmonary vein (PV) was detected by multipolar spiral mapping catheter at each PV with careful evaluation of PV potentials and by 3D-mapping in 16/22 patients (73%) after PFA-PVI and in 33/44 (75%) after CBA-PVI (P = 1.000). Of 82 initially isolated PVs after PFA-PVI, 31 (38%) were reconducting; of 169 isolated PVs after CBA-PVI, 63 (37%) were reconducting (P = 0.936). Clinical atrial tachycardia occurred similarly in patients after PFA (5/22; 23%) and CBA (7/44; 16%; P = 0.515). Roof lines were set more often after PFA- (8/22; 36%) compared with CBA-PVI (5/44; 11%; P = 0.023). Repeat procedure duration [PFA: 87 (76, 123) min; CBA: 93 (75, 128) min; P = 0.446] was similar and fluoroscopy time [PFA: 11 (9, 14) min; CBA: 11 (8, 14) min; P = 0.739] equal between groups at repeat ablation. Conclusion: During repeat ablation after previous PFA- or CBA-based PVI, electrical PV-reconduction rates and patterns were similar.

KW - Atrial fibrillation

KW - Cryoballoon

KW - Reisolation

KW - Pulsed-field ablation

KW - Pulmonary vein isolation

KW - Reconduction

KW - Repeat ablation

KW - Atrial tachycardia

U2 - 10.1093/europace/euae221

DO - 10.1093/europace/euae221

M3 - Article

SN - 1099-5129

VL - 26

JO - Europace

JF - Europace

IS - 9

M1 - euae221

ER -