Second-generation cryoballoon ablation for recurrent atrial fibrillation after an index cryoballoon procedure: a staged strategy with variable balloon size

Purpose Currently, information on the optimal approach of redo procedures for paroxysmal atrial fibrillation (PAF) is limited. Radiofrequency ablation is the preferred technique, with reported success rates of 50–70% at 1–2 years, whereas only few reports exist on redo cryoballoon (CB) ablations. We describe outcomes on a systematic approach of repeat procedures with a second-generation cryoballoon (CB-2) after a successful index CB ablation. Methods Cohort study of 40 consecutive patients with recurrent PAF (55% male), median CHA 2 DS 2 -VASc score 1 (IQR 0–3). Per protocol, a staged variable balloon size strategy was followed with a different balloon size during the redo as compared to the index procedure. Minimal follow-up was 12 months (median 17 months [IQR 14–39]). Results Overall, 120 pulmonary veins (PVs) (75%) showed chronic isolation: 64% (41/64) for first-generation cryoballoon (CB-1) and 82% (79/96) for CB-2 index procedures, respectively ( p = 0.01). The overall mean number of reconnected PVs per patient was 1.0 (40/40): 1.4 for CB-1 and 0.7 for CB-2 index procedures ( p = 0.008). Phrenic nerve palsies ( n = 7) resolved before the end of the procedure. At 1 year, 70% of patients were free of recurrent AF. In multivariate analysis, the only independent predictor of recurrence was the number of prior cardioversions. Conclusions A systematic approach of repeat procedures with a CB-2 using a different balloon size than during the index CB ablation is safe, with acceptable 1-year outcomes. Future comparative studies on the optimal redo technique and approach are warranted to further improve rhythm control in AF.