Aims 

The main cause of atrial fibrillation recurrence after catheter ablation is pulmonary vein reconnection. The purpose of this retrospective study was to analyse the electophysiological findings in patients undergoing repeat procedures after an index cryoballoon ablation (CB-A) and presenting with permanency of pulmonary vein isolation (PVI) in all veins. In addition, we sought to compare the latter with a similar group of patients with reconnected veins at the redo procedure.

Methods 

A total of 132 patients (81 men, 60.7 ± 12.4 years) who underwent CB-A for paroxysmal atrial fibrillation (PAF) were enrolled. Indication for the redo procedure was symptomatic PAF in 83 (63%), persistent atrial fibrillation (PerAF) in 32 (24%) or persistent regular atrial tachycardia (RAT) in 17 (13%) patients.

Results 

Seventy-five (57%) patients presented a pulmonary vein reconnection (pulmonary vein group) during the redo procedure, whereas 57 (43%) had no pulmonary vein reconnection (non-pulmonary vein group). The non-pulmonary vein group exhibited significantly more non-pulmonary vein foci and atrial flutters than the pulmonary vein group after induction protocol (51 vs. 24%, P = 0.002 and 67 vs. 36%, P = 0.003, respectively). Twenty-two (29.3%) patients of the pulmonary vein group and 20 (35%) patients of the non-pulmonary vein group had atrial fibrillation/RAT recurrence after a mean follow-up of 12.5 ± 8 months. The survival analysis demonstrated no statistical significance in recurrence between both groups (log rank P = 0.358).

Conclusion 

Atrial fibrillation/RAT recurrence in patients after CB-A with durable PVI is significantly associated with non-pulmonary vein foci and atrial flutters. No statistically different success rate regarding atrial fibrillation/RAT freedom was detected between the pulmonary vein and non-pulmonary vein groups after redoing RF-CA.

中文翻译：

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阵发性心房颤动冷冻消融术后孤立静脉患者的电生理学结果。

 目标

导管消融后房颤复发的主要原因是肺静脉重连。这项回顾性研究的目的是分析在指数冷冻球囊消融 (CB-A) 后接受重复手术并在所有静脉中出现永久性肺静脉隔离 (PVI) 的患者的电生理学结果。此外，我们试图将后者与在重做手术中重新连接静脉的类似患者组进行比较。

 方法

共有 132 名因阵发性心房颤动(PAF) 接受 CB-A 的患者（81 名男性，60.7 ± 12.4 岁）入组。重做手术的指征是 83 名 (63%) 患者出现症状性 PAF，32 名 (24%) 患者出现持续性房颤(PerAF)，17 名 (13%) 患者出现持续性规律性房性心动过速 (RAT)。

 结果

75 名 (57%) 患者在重做过程中出现肺静脉再连接（肺静脉组），而 57 名 (43%) 患者没有肺静脉再连接（非肺静脉组）。诱导方案后，非肺静脉组比肺静脉组表现出明显更多的非肺静脉病灶和心房扑动（分别为 51% vs. 24%， P = 0.002 和 67% vs. 36%， P = 0.003）。平均随访 12.5 ± 8 个月后，肺静脉组 22 名 (29.3%) 患者和非肺静脉组 20 名 (35%) 患者出现房颤/RAT 复发。生存分析表明两组之间的复发率没有统计学意义（对数等级P = 0.358）。

 结论

CB-A 后伴有持久 PVI 的患者心房颤动/RAT 复发与非肺静脉病灶和心房扑动显着相关。重做 RF-CA 后，肺静脉组和非肺静脉组之间在房颤/RAT 自由度方面没有发现统计学差异。