Clinical Outcome of Cryoballoon Ablation for Long‐Standing Persistent Atrial Fibrillation: From the Korean Cryballoon Ablation Registry

Introduction Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) is considered an effective primary strategy for early persistent atrial fibrillation (AF). However, data regarding CBA for long‐standing persistent AF (PeAF) are limited. We evaluated the efficacy and safety of CBA for long‐standing PeAF compared to PeAF. Methods The study included 1484 patients with non‐paroxysmal AF from Korean CBA registry data with follow‐up of > 12 months after de novo CBA. The primary outcome was recurrence of atrial tachyarrhythmias (ATs) of ≥ 30‐s after a 3‐month blanking period. Results A total of 367 PeAF (25%) and 1117 long‐standing PeAF (75.3%) patients (mean age 61.9 ± 9.6 years, 80% men) underwent de novo CBA. Compared to patients with PeAF, patients with long‐standing PeAF had more heart failure, previous stroke or transient ischemic attack, chronic kidney disease, higher CHA 2 DS 2 ‐VASc score, and larger left atrium (LA). During a mean follow‐up period of 15.1 ± 10.9 months, ATs recurrence occurred in 41.4% of PeAF and 40.1% of long‐standing PeAF. Multivariate analysis showed that female gender (hazard ratio [HR]: 1.31, p = 0.01), larger LA ≥ 45 mm (HR: 1.53, p < .001) and LA volume index ≥ 51 mL/m 2 (HR: 1.77, p < 0.001), and longer AF duration ≥ 5 years (HR: 1. 33, p = .003) were associated with ATs recurrence. After propensity score matching, larger LA was an independent factor for ATs recurrence. Conclusions During a long‐term follow‐up period after index CBA in patients with non‐paroxysmal AF, ATs recurrence rate was similar between PeAF and long‐standing PeAF. CBA might be an effective strategy as an initial rhythm control therapy regardless of AF type.