Atrial fibrillation burden and symptom, quality of life, and healthcare resource utilization after cryoballoon ablation in persistent atrial fibrillation

Aims To investigate the relationship between continuously monitored atrial fibrillation (AF) burden after cryoballoon ablation (CBA) and improvements in AF-related symptoms, quality of life (QoL), and AF-related healthcare resource utilization (HCRU) in early persistent AF. Methods and results This secondary analysis of the multicentre COOL-PER trial included patients with early persistent AF who underwent CBA and continuous monitoring via an implantable loop recorder. Post-CBA AF burden was defined as the percentage of time in AF between 9- and 12-month after CBA, categorized as <0.1%, 0.1 to <10%, and ≥10%. Symptom improvement was assessed using the European Heart Rhythm Association symptom score and QoL with the SF-36 survey. AF-related HCRU was defined as rhythm control interventions after the 90-day blanking period and cardiovascular-related hospitalizations or emergency room visits. Among 130 patients (mean baseline AF burden 77 ± 34%), AF burden significantly decreased post-CBA, with 50.0% achieving <0.1%, 28.5% in 0.1 to <10%, and 21.5% ≥ 10%. Symptom improvement rate was highest in the <0.1% group (89.2%), followed by the 0.1 to <10% (78.4%) and ≥10% (46.4%) groups (P < 0.001). Significant QoL improvement was observed in the <0.1% and 0.1 to <10% groups but not in the ≥10% group. Rhythm control interventions and cardiovascular-related hospitalizations or emergency room visits were more frequent in the ≥10% group (29%, 43%) than in the 0.1 to <10% (5.4%, 22%) and <0.1% (1.5%, 7.7%) groups (both P < 0.001). Conclusion In early persistent AF, lower AF burden 1-year post-CBA was associated with greater AF-related symptom improvement, significant QoL enhancement, and reduced HCRU during follow-up.