Document 6530927

The Need for Repeat Ablation Following Pulmonary Vein Isolation With Both the First and Second Generation Arctic
Front Cryoballoon: A Single Center Analysis
Matt Brunson, MD, Kevin R. Wheelan, MD, Robert C. Kowal, MD/PhD, Alan Donsky, MD, Jay Franklin, MD, Cathy Headley, RN, David Michaels, B.A., Naveed Sarmast, MPH
Introduction
Methods
Results
• PVI using the first generation
cryoballoon catheter(CB-Gen1) has
been proven to be effective for patients
with symptomatic paroxysmal atrial
fibrillation.
 Single center, retrospective analysis.
• The second generation cryoballoon
catheter(CB-Gen2) has been developed
providing more uniform cooling over
the balloon surface area, thereby
theoretically improving the efficacy of
PVI.
 The first 303 cases were performed with CBGen1. The next 239 cases were performed
with CB-Gen2.
Objectives
 542 consecutive patients with drug-refractory
paroxysmal or early persistent AF underwent
their first PVI with a cryoballoon catheter.
 The mean follow-up time was 271 days for
CB-Gen1 and 264 days for CB-Gen2.
Pulmonary Vein Reconnection
 Of the 303 patients treated with CBGen1, 18 (6%) underwent repeat ablation
within the follow up period, and 16 (89%)
of these had pulmonary vein
reconnection. Of the 239 patients
treated with CB-Gen2, 5 (2%) underwent
repeat ablation within the follow up
period, and 3 (60%) of these had
pulmonary vein reconnection.
 Unadjusted analysis demonstrates a
significantly lower voluntary rate of
repeat AF ablation procedures when CBGen2 was used for the index PVI
compared with CB-Gen1 (unadjusted
Relative Risk=2.83; 95%CI: 1.06, 7.53).
Isolated Pulmonary Veins
LUPV
LLPV
RUPV
RLPV
Reconnected Pulmonary Veins
LUPV
LLPV
Methods - Clinical Endpoint
Repeat Ablations
 1) To determine the need for repeat
ablation for recurrent symptomatic atrial
fibrillation (AF) after pulmonary vein
isolation (PVI) with CB-Gen1 vs CBGen2.
 2) To determine the incidence of
pulmonary vein reconnection (PVR) at
the time of repeat ablation for recurrent
AF.
 1) The number of repeat ablations
performed due to recurrent symptomatic
AF.
 2) The incidence of PVR at repeat
ablation.
 Repeat procedures were performed at
the discretion of each patient and their
physician.
Catheter
Number of
Mean
Incidence of
Cases
Follow-up Repeat Ablation
CB-Gen1
303
271 days
6% (18 pt’s)
CB-Gen2
239
264 days
2% (5 pt’s)
Catheter
Incidence of Pulmonary Vein
Reconnection at Repeat Ablation
CB-Gen1
89% (16 pt’s)
CB-Gen
60% (3 pt’s)
Conclusions
 In our single center analysis, the use
of CB-Gen2 was associated with a
lower incidence of repeat ablation for
AF among patients undergoing
cryoballoon-based PVI.
Disclosures
M. Brunson: None. K.R. Wheelan: Speakers Bureau, Significant, Medtronic; Ownership Interest, Significant, Medtronic; Consultant/Advisory Board, Significant, Medtronic. R.C. Kowal: Consultant/Advisory Board, Significant, Medtronic. J Franklin: Medtronic Speakers Bureau. Alan
Donsky: None. C Headley: None. D Michaels: None. N Sarmast: None