Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA)

Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8±10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs 11.4%; p<0.001) and left atrium dilation (72.6 vs 43.3%; p<0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs 22.2%; p<0.001), with an arterial line (32.2 vs 44.6%; p<0.001) and assisted transeptal puncture (11.9 vs 17.9%; p=0.025). During an application, PeAF patients had a longer time to -30°C (35.91±14.20 vs 34.93±12.87 sec; p=0.021) and a colder balloon nadir temperature during vein isolation (-35.04±9.58 vs -33.61±10.32ºC; p=0.004), but received fewer bonus freeze applications (30.7 vs 41.1%; p<0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p=0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.