• Miki Yokokawa, Aman Chugh, Rakesh Latchamsetty, Hamid Ghanbari, Thomas Crawford, Krit Jongnarangsin, Ryan Cunnane, Mohammed Saeed, Bipin Sunkara, Mehmet Tezcan, Frank Bogun, Frank Pelosi, Fred Morady, and Hakan Oral.
• Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
• Heart Rhythm. 2018 Dec 1; 15 (12): 1835-1841.

BackgroundThe role of cryoballoon ablation (CBA) for antral pulmonary vein isolation (APVI) has not been well established in persistent atrial fibrillation (PerAF). Isolation of the left atrial posterior wall (BOX) after APVI has been suggested to improve the efficacy of radiofrequency catheter ablation (RFA) in PerAF.ObjectiveThe purpose of this study was to compare characteristics and clinical outcomes of APVI by CBA vs APVI + BOX by contact force-guided RFA (CF-RFA) in patients with PerAF.MethodsAPVI was performed in 167 consecutive patients with PerAF (mean age 64 ± 9 years; left atrial diameter 46 ± 6 mm) using CBA (n = 90) or CF-RFA (n = 77). After APVI, a roofline was created in 33 of 90 patients (37%) in the CBA group and BOX was performed in all 77 patients in the CF-RFA group.ResultsDuring 21 ± 10 months of follow-up after a single ablation procedure, 37 of 90 patients (41%) in the CBA group (APVI) and 39 of 77 (51%) in the CF-RFA group (APVI + BOX) remained in sinus rhythm without antiarrhythmic drugs (AADs) (P = .22). During repeat ablation, APVI + BOX using CF-RFA was performed in 20 of 90 patients (22%) and in 18 of 77 patients (23%) who initially underwent CBA or CF-RFA, respectively. At 19 ± 10 months after repeat ablation, sinus rhythm was maintained in 55 of 90 patients (61%) and 52 of 77 patients (68%) in the CBA and CF-RFA groups without AADs, respectively (P = .39).ConclusionIn PerAF, an initial approach of APVI by CBA or APVI + BOX by CF-RFA has a similar efficacy of 40%-50% without AADs. After repeat ablation for APVI + BOX by CF-RFA in ∼25%, sinus rhythm is maintained in 60%-70% of patients without AADs.Copyright © 2018 Heart Rhythm Society. All rights reserved.

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