Comparison of regular atrial tachycardia incidence after circumferential radiofrequency versus cryoballoon pulmonary vein isolation in real-life practice.

BACKGROUND

Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation (PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.

OBJECTIVE

To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).

METHODS

All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA-AT) based on invasive mapping procedure findings and ECG P-wave morphology.

RESULTS

The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow-up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA-AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow-up was 3.5%.

CONCLUSION

In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.