# Clinical outcomes of cases requiring touch-up applications in pulmonary vein isolation with balloon ablation

## TL;DR

This study examines touch-up ablation in balloon ablation for atrial fibrillation, finding it's needed in some cases but with manageable risks.

## Contribution

The study provides nationwide clinical evidence on touch-up ablation outcomes in Japan using a large registry.

## Key findings

- Touch-up ablation was needed in 6.4% of balloon ablation cases for PVI.
- The need for touch-up ablation decreased from 9.5% in 2017 to 5.5% in 2020.
- Touch-up ablation had a high acute success rate but a 2.5% risk of phrenic nerve palsy.

## Abstract

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.

This study aimed to investigate the current status and outcomes of touch-up applications using a nationwide registry in Japan.

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.

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.

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.