Reason that CBA might be better than RFA
The main point we should discuss in this article is the reason that the rate of AF recurrence was lower in the CBA group than in the RFA group. An optimized isolation might be based on the continuous lesion and the depth of the lesion. To our knowledge, no study has compared lesion depth between CBA and RFA. Only one case report performed a histological analysis on HD patients who underwent CBA.17 Despite being a case report, we confirmed the presence of a transluminal wide lesion in the PV antrum after the second-generation CBA in HD patients. Kurose et al. reported that the lesion assessed by late gadolinium enhancement MRI after CBA was wider and more continuous than that after RFA.18 When a large lesion such as in non-PVI is needed, RFA might be suitable. However, when the target lesion is on the PV, CBA might be suitable, especially for patients on dialysis because more continuous lesions could be confirmed.
Furthermore, in a previous report about AF recurrence, reconduction of PV was observed in 83.3% of HD patients with a recurrence of AF and in 86.4% of non-HD patients with a recurrence of AF. This result indicates that the durability of PVI is necessary in HD patients as well as in non-HD patients.19