Background: Pulmonary vein isolation (PVI) is the cornerstone of ablation in AF patients. Cryoballoon ablation (CBA) is a safe and effective strategy to achieve durable PVI in the first procedure, however patients still experience recurrence of atrial arrhythmias. The aim was to assess the durability of PVI in patients undergoing repeat ablation after initial advanced CBA.

Methods: From the local prospective observational single-center registry all patients undergoing repeat ablation after initial CBA due to recurrence were included in this analysis. Patients with a prior first generation CBA or RFA were excluded. At repeat ablation, 3D electroanatomical imaging of the LA was performed prior to RFA. 

Results: A total of 2,410 patients underwent cryoballoon PVI (CBG 2,3,4) between May 2012 and March 2021 at our center. After a median FU of 15 months, 219 patients (9.1%) underwent repeat ablation, after initial advanced CBA. 53 (24%) of the patients presented with paroxysmal AF, 166 (76%) with persistent AF. Median age was 70 years. 127 (58%) were male, 93 (42%) were female. 139 patients (63.4%) showed durable PVI of all veins. 87 % of the veins were still isolated. Details are shown in table 1 and 2. 

Conclusion: Cryoballoon ablation is an effective procedure to achieve durable PVI. Hence at repeat ablation PV reconnection is not common anymore. Strategies for PVI non-responders should be defined in the future. Detailed analysis and understanding of the underlying mechanism of the arrhythmia, substrate analysis and individualized ablation might require high-density mapping in the second ablation procedure. 

Table 1