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