A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience.

Background: Pulmonary vein (PV) reconnection after radiofrequency (RFC) or cryoballoon (CB) pulmonary vein isolation (PVI) is common.

Method: We report a single-center experience of 156 patients who underwent a redo procedure-ablation strategy for recurrent atrial fibrillation (AF) in a reverse sequence after a failed index RFC or CB PVI.

Results: A total of 60 patients after index CB PVI underwent RFC-redo ablation (CB-RFC redo), and 96 patients after index RFC PVI underwent CB-redo ablation (RFC-CB redo). During the redo procedure, the proportion of patients with PV reconnection was lower after index CB PVI procedure compared with the proportion of patients after index RFC PVI (88.3% versus 98.9%, p = 0.01). Additionally, a mean number of 1.50 ± 0.8 PVs/patient were reconnected after index CB PVI, compared with 3.36 ± 0.9 PVs/patient after index RFC PVI (p = 0.001). Patients after index RFC PVI frequently presented with ≥ 3 reconnected PVs, compared with index CB PVI (70.8% vs 10%, p < 0.001). At a 2-year follow-up, 43 patients (27.6%) developed recurrence after redo ablation, with a similar AF-free outcome (CB-RFC redo:73.3% vs RFC-CB redo: 71.9%, p = 0.873). In the multivariate analysis, persistent AF (HR = 2.107, 95% CI: 1.085-4.091, p = 0.028) and early AF recurrence after the initial ablation (HR = 2.431, 95% CI: 1.279-4.618, p = 0.007) were independent predictors of AF recurrence.

Conclusions: The extent and distribution of PV reconnections were different after index RFC and CB PVI procedures. Alternating CB or RFC ablation technique strategy is effective with a similar long-term outcome, and it may be an appropriate option for repeated AF ablation.