Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-132 - Pattern Of Pulmonary Vein Reconnection Following Current Radiofrequency Vs. Cryoballoon Catheter Ablation For Paroxysmal Arial Fibrillation In A Randomized Trial With Mandatory Re-look Procedure (The RACE-AF Trial) (ID 334)

Disclosure
 S.K. Sørensen: Nothing relevant to disclose.

Abstract

Background: In the first randomized trial of pulmonary vein isolation (PVI) by either radiofrequency (RF) or cryoballoon (CRYO) catheter ablation with a protocol-mandated re-look procedure, we found similar overall durability of PVI (The RACE-AF trial, NCT03805555).
Objective: To assess the detailed pattern of segmental lesion durability in the RF vs CRYO groups.
Methods: Ninety-eight patients (pts) had PVI by either contact force sensing RF catheters, or by a 3-minute single freeze and conditional bonus freeze protocol with the 28mm, 2nd gen. cryoballoon. After 4-6 months PVI was re-assessed using an electroanatomical mapping system (CARTO) and a multipole mapping catheter. Sites of reconnection were re-isolated with RF and assigned to one of the 16 pulmonary vein (PV) segments (fig 1).
Results: Durable isolation of all veins was found in 24/49 (49%) vs 23/49 (47%) of pts in the RF vs CRYO group (ns). This corresponded to 155/199 (78%) vs 163/201 (81%) of primarily isolated PVs that remained durably isolated (RF vs CRYO, ns). For the left sup. PV this was 82% vs 90%, for the left inf. 80% vs 82%, for the right sup. 80% vs 83%, and for the right inf. PV 73% vs 76% (all RF vs CRYO, ns). The pattern of segmental lesion durability is shown in fig 1. There was no significant difference between the two methods for any segment, but a trend towards RF underperforming in the posterior wall segments on both sides, and CRYO underperforming in the right inf. segments.
Conclusion: Current RF and CRYO catheter ablation methods produced PVI of similar moderate to high long-term durability. Improvements in lesion durability are still needed, especially in posterior wall and right inf. aspects of PVs.
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