Outcomes of adjunct posterior wall isolation in atrial fibrillation patients with cardiac implantable electronic devices.

Background: Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI). Methods: This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF). Results: Acute PVI was achieved in all patients using cryoballoon ablation. Compared to PVI alone, PVI+PWI was associated with longer cryoablation, fluoroscopy, and total procedure times. Adjunct radiofrequency was required to complete PWI in 29/77 patients (37.7%). Adverse events were similar with PVI alone versus PVI+PWI. But at 24 ± 7 months of follow‐up, not only cryoballoon PVI+PWI was associated with improved freedom from recurrent AF (74.3% vs. 46.0%, P =.007) and all atrial tachyarrhythmias (71.4% vs. 38.1%, P =.001) in patients with PersAF, cryoballoon PVI+PWI also yielded greater freedom from AF (88.1% vs. 63.7%, P =.003) and all atrial tachyarrhythmias (83.3% vs. 60.8%, P =.008) in those with PAF. Additionally, PVI+PWI was associated with higher reductions in atrial tachyarrhythmia burden (97.9% vs. 91.6%, P <.001), need for cardioversion (5.2% vs. 23.6%, P <.001) and repeat catheter ablation (10.4% vs. 26.1%, P =.005), and a longer time‐to‐arrhythmia recurrence (16 ± 6 months vs. 8 ± 5 months, P <.001) in both PersAF and PAF patients. Conclusion: In CIED patients with PersAF or PAF, cryoballoon PVI+PWI is associated with a greater freedom from recurrent AF and atrial tachyarrhythmias, as compared to PVI alone during long‐term follow‐up. [ABSTRACT FROM AUTHOR]