Repeat Ablation for Atrial Fibrillation Recurrence Post Cryoballoon or Radiofrequency Ablation in the FIRE AND ICE Trial
Karl-Heinz Kuck, Jean-Paul Albenque, K.R. Julian Chun, Alexander Fürnkranz, Mathias Busch, Arif Elvan, Michael Schlüter, Kendra M. Braegelmann, Fred J. Kueffer, Lauren Hemingway, Thomas Arentz, Claudio Tondo, Josep Brugada, FIRE AND ICE Investigators, Karl-Heinz Kuck, Andreas Metzner, Thomas Fink, Christine Lemes, Julian Chun, Shaojie Chen, Boris Schmidt, Fabrizio Bologna, Stefano Bordignon, Arif Elvan, Mohamed Mouden, Thomas Arentz, Björn Müller-Eschenborn, Amir Jadidi, Michael Kühne, Christian Sticherling, Mathias Busch, Anne Krüger, Edison Abdiou, Lluis Mont, Eva Maria Benito Martín, Francisco Alarcón Sanz, Petr Neuzil, Libor Dujka, Ricardo Ruiz-Granell, Alberto Barrera, Amalio Ruiz Salas, Jean- Paul Albenque, Serge Boveda, Volker Kühlkamp, Bogdan Stanciu, Nicasio Pérez-Castellano, Julián Pérez Villacastín, Victoria Canadas Godoy, Karl-Heinz Kuck, Jean-Paul Albenque, K.R. Julian Chun, Alexander Fürnkranz, Mathias Busch, Arif Elvan, Michael Schlüter, Kendra M. Braegelmann, Fred J. Kueffer, Lauren Hemingway, Thomas Arentz, Claudio Tondo, Josep Brugada, FIRE AND ICE Investigators, Karl-Heinz Kuck, Andreas Metzner, Thomas Fink, Christine Lemes, Julian Chun, Shaojie Chen, Boris Schmidt, Fabrizio Bologna, Stefano Bordignon, Arif Elvan, Mohamed Mouden, Thomas Arentz, Björn Müller-Eschenborn, Amir Jadidi, Michael Kühne, Christian Sticherling, Mathias Busch, Anne Krüger, Edison Abdiou, Lluis Mont, Eva Maria Benito Martín, Francisco Alarcón Sanz, Petr Neuzil, Libor Dujka, Ricardo Ruiz-Granell, Alberto Barrera, Amalio Ruiz Salas, Jean- Paul Albenque, Serge Boveda, Volker Kühlkamp, Bogdan Stanciu, Nicasio Pérez-Castellano, Julián Pérez Villacastín, Victoria Canadas Godoy
Abstract
Background: The FIRE AND ICE trial assessed efficacy and safety of pulmonary vein (PV) isolation using cryoballoon versus radiofrequency current (RFC) ablation in patients with drug refractory, symptomatic, paroxysmal atrial fibrillation (AF). The purpose of the current study was to assess index lesion durability as well as reablation strategy and outcomes in trial patients undergoing a reablation procedure.
Methods: Patients with reablation procedures during FIRE AND ICEwere retrospectively consented and enrolled at 13 trial centers. The first reablation for each patient was included in the analysis. Documented arrhythmias before reablation, number and location of reconnected PVs, lesions created during reablations, procedural characteristics, and acute as well as long-term outcomes were assessed.
Results: Eighty-nine (36 cryoballoon and 53 RFC) patients were included in this study. Paroxysmal atrial fibrillation was the predominant recurrent arrhythmia (69%) before reablation. Reablations occurred at a median of 173 and 182 days (P=0.54) in the cryoballoon and RFC cohorts, respectively. The number of reconnected PVs was significantly higher in the RFC than the cryoballoon group (2.1±1.4 versus 1.4±1.1; P=0.010), which was driven by significantly more reconnected left superior PVs and markedly more reconnected right superior PVs. The number of (predominantly RFC) lesions applied during reablation was significantly greater in patients originally treated with RFC (3.3±1.3 versus 2.5±1.5; P=0.015) with no difference in overall acute success (P=0.70). After reablation, no differences in procedure-related rehospitalization or antiarrhythmic drug utilization were observed between cohorts.
Conclusions: At reablation, patients originally treated with the cryoballoon had significantly fewer reconnected PVs, which may reflect RFC catheter instability in certain left atrial regions, and thus required fewer lesions for reablation success. Repeat ablations were predominantly performed with RFC and resulted in similar acute success, duration of hospitalization, and antiarrhythmic drug prescription between the study cohorts.
Trial registration: ClinicalTrials.gov NCT03314753.
Keywords: atrial fibrillation; catheter ablation; hospitalization; pulmonary veins; randomized controlled trial.
Source: PubMed