Early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation strongly predicted procedural failure, significantly increasing the risk of late recurrences (HR 15.2).
Observational (n=100)
No
Does early recurrence of atrial arrhythmias predict 12-month procedural failure in patients undergoing pulmonary vein cryoballoon ablation for atrial fibrillation?
Early recurrences of atrial arrhythmias within 45 days after cryoballoon ablation strongly predict late procedural failure, challenging the utility of the traditional 3-month blanking period.
Effect estimate: HR 15.2 (95% CI 6.42-35.99)
Absolute Event Rate: 83.9% vs 6.06%
p-value: p=0.019
BACKGROUND: Early recurrences of atrial arrhythmias (ERAA) after atrial fibrillation (AF) catheter ablation do not predict procedural failure. A well-demarcated homogeneous lesion delivered by cryoballoon is less arrhythmogenic, and the recommended three-months blanking period may not refer to cryoballoon ablation (CBA). OBJECTIVE: We aimed to evaluate the predictive role of ERAA after second-generation CBA using an implantable loop recorder. METHODS: This prospective observational study enrolled 100 patients (58 males, median age 58) with paroxysmal/persistent AF undergoing pulmonary vein (PV) CBA using second-generation cryoballoon with simultaneous ECG loop recorder implantation. The duration of follow-up was 12 months, with scheduled visits at 3, 6 and 12 months. RESULTS: 99 patients from 100 completed the 12-month follow-up period. ERAA occurred in 31.3 % of patients. 83.9 % of patients with ERAA also developed late recurrences. The 12-month freedom from AF in patients with ERAA was significantly lower than in those without ERAA (p < 0.0001). Non-paroxysmal AF and longer arrhythmia history were associated with increased risk of both early (HR 3.27; 95 % CI 1.32-8.08; p = 0.010 and HR 1.0147; 95 % CI 1.008-1.086; p = 0.015, respectively) and late recurrences (HR 3.89; 95 % CI 1.67-9.04; p = 0.002 and HR 1.0142; 95 % CI 1.007-1.078; p = 0.019, respectively) of AF. ERAA were another predictor for procedural failure (HR 15.2; 95 % CI (6.42-35.99; p = 0.019). CONCLUSIONS: ERAA occurred in the third of the patients after PV second-generation CBA and are strongly associated with procedural failure. Longer duration of AF history and persistent AF are independent predictors of AF's early and late recurrence.
Davtyan et al. (2021) conducted an observational in Paroxysmal or persistent atrial fibrillation (n=100). Early recurrences of atrial arrhythmias (ERAA) vs. No ERAA was evaluated on Procedural failure (late recurrences of atrial fibrillation) (HR 15.2, 95% CI 6.42-35.99, p=0.019). Early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation strongly predicted procedural failure, significantly increasing the risk of late recurrences (HR 15.2).