Introduction

Despite advances in safety and efficacy of pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence remains a common problem after PVI for rhythm-control treatment of AF. PV reconduction is frequently observed during AF reablation procedures. Several factors including patients’ anatomy and energy source predispose to electrical reconduction of PVs and might have an impact on patient management, e.g., to devote specific attention to certain veins during index procedures. 

Methods and results

Data mining in 8759 PVI-procedures for AF performed between 09/2008 to 05/2021 was performed. Success rates of PVI using cryoballoon and radiofrequency ablation energy were compared between veins using Fisher’s exact test. The distribution of reconduction between all PVs was analyzed via Chi-square test. A two-sided p ≤ 0.05 was considered significant.

Of 4312 patients undergoing a first PVI using radiofrequency (RF, 3043 patients) or cryo-balloon ablation (CBA, 1269 patients), 936 underwent at least one repeat ablation procedure with a median time-to-redo of 408 days (interquartile range 206 days, 912 days). 730 (78%) patients had RF based ablation and 206 (22%) had CBA for index PVI. Recovery of PV conduction in at least one PV was found in 786 (84%) procedures. Details of reconducting PVs are visualized in Figure 1. After CBA, the right PVs (RIPV, RSPV) showed more recovery than the left PVs (LIPV 38%, LSPV 34%) with frequent RIPV-reconduction (RIPV 56%, RSPV 48%). This trend was attenuated in patients undergoing RF-PVI (RIPV 51%, RSPV 52%, LIPV 40%, LSPV 41%). In direct comparison of both modalities, reconduction of the LSPV was less frequent after CBA compared to RF (p=0.0247). 

Conclusions

These results suggest that PV reconduction of right sided PVs is more often observed than of left sided PVs in both cryoballoon and RF ablation procedures. RF ablation is associated with preferential reconduction of the left superior PV.