Electrophysiologic and anatomic factors predictive of a need for touch‐up radiofrequency application for complete pulmonary vein isolation: Comparison between hot balloon‐ and cryoballoon‐based ablation

摘要

Abstract Introduction Although electrophysiologic and anatomic factors associated with the need for touch‐up radiofrequency (RF) applications after cryoballoon ablation (CBA) for atrial fibrillation (AF) have been well described, those associated with the need for such touch‐up after hot balloon ablation (HBA) have not. We aimed to identify factors predictive of the need for touch‐up applications following HBA. Methods Anatomic and electrophysiologic factors predictive of the need for touch‐up RF ablation were compared between 46 propensity score‐matched pairs of patients who underwent HBA or CBA for AF. Results Touch‐up RF ablation was more frequently required after HBA than after CBA (57% vs 30%, respectively; P ?=?.01), and mostly at the anterior aspect of the left superior pulmonary vein (LSPV) carina after HBA (35%) but at the inferior aspect of the right inferior PV (RIPV) after CBA (71%). Post HBA touch‐up was associated with male gender, a CHA 2 DS 2 ‐VASc score?≤?2, PV‐left atrial bipolar voltage?≥?1.35?mV, and PV trunk length?≥?24.0?mm; post CBA touch‐up associated with a history of heart failure. Conclusion Following balloon ablation for AF, there may be a need for touch‐up applications, especially at the LSPV ridge after HBA but at the RIPV after CBA. It may behoove operators to expect a need for touch‐up following HBA when patients are male, have a CHA 2 DS 2 ‐VASc score?≤?2 points, when PV‐LA bipolar voltage is?≥?1.35?mV, or when the PV trunk is?≥?24.0?mm or following CBA when there is a history of heart failure.