Key result
An NT-proBNP reduction rate of ≥60.7% at 1 month strongly predicted 1-year arrhythmia-free status in patients with persistent atrial fibrillation undergoing cryoballoon ablation.
Why the study?
In patients with persistent AF, outcomes are poor with PV isolation alone, and the effectiveness and predictors of success for adding LA roof ablation remain unclear.
Does left atrial roof ablation combined with pulmonary vein isolation using a cryoballoon prevent arrhythmia recurrence in patients with persistent atrial fibrillation?
Cohort (n=65)
No
Does left atrial roof ablation combined with pulmonary vein isolation using a cryoballoon prevent arrhythmia recurrence in patients with persistent atrial fibrillation?
Effect estimate: OR 0.937 (95% CI 0.891-0.985)
p-value: p=0.010
In patients with persistent AF, adding LA roof ablation to PV isolation using a cryoballoon is feasible with a high arrhythmia-free rate, and a ≥60.7% reduction in NT-proBNP at 1 month strongly predicts procedural success.
May aid post-ablation risk stratification in persistent AF; hypothesis-generating in a small retrospective cohort and requires prospective validation.
Pulmonary vein (PV) isolation by catheter ablation is a widely used curative therapy for atrial fibrillation (AF). However, in patients with persistent AF (PeAF), long-term outcomes are poor when PV isolation is performed alone. Although left atrial (LA) roof ablation is sometimes added to PV isolation, its effectiveness and predictors of success remain unclear. To identify predictors of arrhythmia recurrence in patients with PeAF undergoing LA roof ablation and PV isolation using a cryoballoon catheter. A retrospective assessment of LA roof ablation and PV isolation using a cryoballoon was performed in 65 consecutive patients with PeAF. The median age of the patients was 69 years [Q1:61, Q3:75]; 55% were female, and 49% had longstanding PeAF. The complete LA roof block success rate using a cryoballoon was 92.3%, with no esophagus-related complications. The 1-year post-ablation arrhythmia-free rate was 83.3%. Atrial arrhythmia recurrence was more common within the 3-month blanking period. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reduction rate ≥60.7% and sinus rhythm at 1-month post-ablation, and no arrhythmia during the 3-month blanking period strongly predicted arrhythmia-free status at 1 year post-ablation. In patients with PeAF who underwent LA roof ablation and PV isolation using a cryoballoon, the arrhythmia-free rate was high. The NT-proBNP reduction rate at 1-month post-ablation may serve as a simple and potentially useful predictor of procedural success.
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Nomura et al. (2025) conducted a cohort in Persistent atrial fibrillation (n=65). Cryoballoon pulmonary vein isolation and left atrial roof ablation was evaluated on Recurrence of atrial arrhythmia (OR 0.937, 95% CI 0.891-0.985, p=0.010). An NT-proBNP reduction rate of ≥60.7% at 1 month strongly predicted 1-year arrhythmia-free status in patients with persistent atrial fibrillation undergoing cryoballoon ablation.
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