Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Aug 30;26(9):euae221.
doi: 10.1093/europace/euae221.

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

Marc D Lemoine  1   2 , Julius Obergassel  1   2 , Sandro Jaeckle  1 , Moritz Nies  1   2 , Sophia Taraba  1 , Celine Mencke  1 , Jan Rieß  1   2 , Ilaria My  1   2 , Laura Rottner  1   2 , Fabian Moser  1   2 , Djemail Ismaili  1   2 , Bruno Reißmann  1   2 , Feifan Ouyang  1   2 , Paulus Kirchhof  1   2   3 , Andreas Rillig  1   2 , Andreas Metzner  1   2
Affiliations
Comparative Study

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

Marc D Lemoine et al. Europace. .

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

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow chart of patients included in this prospective observational study (STROBE format). AF, Atrial fibrillation; AT, Atrial tachycardia; CBA, Cryoballoon ablation; PFA, Pulsed-field ablation; PV, Pulmonary vein.
Figure 2
Figure 2
Overview of findings at repeat procedures comparing pulsed-field ablation (PFA) and cryoballoon-ablation (CBA) at index pulmonary vein isolation (PVI). Subplot A shows indications for repeat procedures, which was recurrence of atrial fibrillation (AF) in most cases. Subplot B shows rate of PV reconduction (B) per index PVI energy group per patient and for all individually counted pulmonary veins. Subplot C shows the latter per individual pulmonary vein. Significant differences between the index PFA and index CBA groups were not observed in this trial.
Figure 3
Figure 3
Location of reconduction gaps after pulsed-field- (PFA) and cryoballoon-based (CBA) index pulmonary vein isolation (PVI). All gaps were individually identified and plotted per procedure. No major differences between PFA- and CBA-based index PVI were identified.
Figure 4
Figure 4
Forest plot of a multivariate logistic regression of seven selected predictors for repeat procedure occurrence within the complete dataset. Significant predictors (P < 0.05, marked in red) were presence of a lefts-sided common PV ostium (LCPV), history of coronary artery bypass graft surgery (CABG), non-paroxysmal atrial fibrillation (AF) at index PVI, arterial hypertension, and age at index PVI.
See this image and copyright information in PMC

References

    1. Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG et al. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024;26:euae043. - PubMed
    1. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020;383:1305–16. - PubMed
    1. Sohns C, Fox H, Marrouche NF, Crijns HJGM, Costard-Jaeckle A, Bergau L et al. Catheter ablation in end-stage heart failure with atrial fibrillation. N Engl J Med 2023;389:1380–9. - PubMed
    1. Avgil Tsadok M, Gagnon J, Joza J, Behlouli H, Verma A, Essebag V et al. Temporal trends and sex differences in pulmonary vein isolation for patients with atrial fibrillation. Heart Rhythm 2015;12:1979–86. - PubMed
    1. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation 2024;149:e1–156. - PMC - PubMed

Publication types

MeSH terms