Abstract
BACKGROUND: Balloon ablation for pulmonary vein isolation (PVI) is a well-established treatment option for atrial fibrillation. Although some patients require touch-up ablation, generalizable evidence is limited. OBJECTIVE: This study aimed to investigate the current status and outcomes of touch-up applications using a nationwide registry in Japan. METHODS: Patients ≥18 years of age who underwent first-time PVI between January 2017 and December 2020 were included using the data from the Japanese Catheter Ablation registry. The annual trends in the proportion of cases requiring touch-up ablation with radiofrequency ablation were determined, and the associations of ablation strategies with acute success and periprocedural complications were analyzed using logistic regression analysis. RESULTS: Of the 51,402 patients included, 28,412 and 22,990 patients underwent PVI using radiofrequency ablation and balloon ablation, respectively. In the balloon ablation group, 1462 (6.4%) patients required touch-up applications, and the proportion of cases requiring touch-up applications decreased during the study period from 9.5% in 2017 to 5.5% in 2020 (P for trend < .001). The proportion of acute success was >99% across all ablation strategies. Although 2.5% of the patients in the touch-up ablation group had phrenic nerve palsy, the composite of complications, except for phrenic nerve palsy, was not significantly increased in the balloon + touch-up ablation group compared with that in the balloon ablation-only group and radiofrequency ablation group. CONCLUSION: Touch-up applications following balloon ablation are required in some cases. Touch-up ablation with radiofrequency ablation may be a treatment option when achieving successful PVI using balloon ablation is difficult.