Long-term outcome of cryoballoon ablation versus radiofrequency ablation for focal atrial tachycardias originating from the pulmonary veins.

PURPOSE: We aimed to investigate the characteristics of focal atrial tachycardias (ATs) arising from the pulmonary veins (PVs), as well as the safety and long-term efficacy of cryoballoon (CB) versus radiofrequency (RF) ablation in this population.

METHODS: Eighty-three patients with ATs arising from PVs from a consecutive series of 487 patients who underwent CB and RF ablation were retrospectively reviewed. Patients who had a prior history of atrial fibrillation (AF) were excluded. The AT origin was confirmed during the conventional electrophysiological study and activation mapping. The ablation approach was at the discretion of the operators.

RESULTS: Thirty-five patients were managed with focal ablation, 25 were ablated with unilateral PV isolation (PVI), and the remaining 23 were performed with CB ablation. All procedures were successfully ablated. There was no significant difference in procedure time between CB group and RF focal group (43.7 ± 11.8 min vs. 45.8 ± 11.2 min, P = 0.121), whereas the fluoroscopy time in CB group was longer than in RF PVI group (10.1 ± 2.5 min vs. 8.4 ± 2.8 min, P < 0.001). There was 1 recurrence in CB group, 4 recurrences of AT in RF focal group, and 2 recurrence in RF PVI group (P = 0.643). Repeat ablation was performed in 6 of 7 patients. Seventy-eight patients were available for long-term follow-up. At a mean of 5.4 ± 4.6-year follow-up, 77 of 78 patients were free from AT without antiarrhythmic medication after 1.1 ± 0.3 procedures. No patient had procedural complications and developed AF during the follow-up period.

CONCLUSIONS: CB ablation is an effective and safe tool to treat ATs originating from the PVs. The ATs originating from the PVs represent an isolated clinical process and are not likely to be the forerunner of a more diffuse process leading to the development of PV AF.