Early Cryoablation After First Diagnosis of Atrial Fibrillation Reduces Arrhythmia Recurrence in Heart Failure Patients

Figures

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  Figure 1. Recurrence After Cryoablation Kaplan-Meyer survival curves of recurrence after ablation between the early- (≤0.5 year) and delayed- (>0.5 year) ablation groups. AF = atrial fibrillation.

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  Figure 2. Mortality and HF Hospitalization After Cryoablation Kaplan-Meyer survival curves of all-cause death (A) and HF hospitalization (B) after ablation between the early- and delayed-ablation groups. AF = atrial fibrillation; HF = heart failure.

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  Figure 3. Increased Recurrence Risk Across the Time to Ablation Kaplan-Meyer survival curves of recurrence-free rates among the 4 groups according to AF duration (<1.0 year, 1.0-3.9 years, 4.0-6.9 years, and ≥7.0 years) in the (A) total ablation group and (B) patients with AF-related HF. Abbreviations as in Figure 2.

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  Figure 4. Success Rate for Cryoablation Among Institutions The success rate for recurrence-free ablation and percentage of patients with early ablation ≤0.5 year in all institutions. The trend line was calculated with an adjustment to the number of the patients in each institution with 95% CIs (dotted lines). Sample-size weighted correlation coefficients and P values are presented.

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  Figure 5. Echocardiography Changes Before and After Ablation Changes in the (A) LAD, LVEDD, and LVEDS and (B) LVEF from baseline to postablation in the early- and delayed-ablation groups. LAD = left atrial diameter; LVEDD = left ventricular end-diastolic diameter; LVEDS = left ventricular end-systolic diameter; LVEF = left ventricular ejection fraction. Values are the mean ± SD.

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  Figure 6. BNP Levels After Cryoablation Changes in BNP levels from baseline to follow-up postablation between the early- and delayed-ablation groups. BNP = B-type natriuretic peptide.

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  Figure 7. Recurrence in the Subgroups of Left Ventricular Ejection Fractions Kaplan-Meyer survival curves of recurrence after ablation between the early- and delayed-ablation groups among (A) patients with left ventricular ejection fraction (LVEF) ≥50% at baseline and (B) those with LVEF <50%. Comparison of the recurrence-free rates among 4 groups according to AF duration (<1.0 year, 1.0-3.9 years, 4.0-6.9 years, and ≥7.0 years) in each group are shown on the right, respectively. Abbreviation as in Figure 1.

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  Figure 8. Recurrence Risk According to LVEF The effect of early ablation (≤0.5 year) vs delayed ablation (>0.5 year) on recurrence with LVEF function as a continuous variable. The figure shows the adjusted HR as a solid black line with the 95% CIs represented as the shaded area. Delayed ablation is used as the reference group. LVEF = left ventricular ejection fraction.

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  Figure 9. Recurrence Across the Subgroups Risk of recurrence for early-ablation vs delayed-ablation across the subgroups stratified by baseline characteristics. Abbreviations as in Figures 2 and 5.

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  Central Illustration. Early Cryoablation for HF Patients Early cryoablation from the first diagnosis of AF reduced the risk of recurrence in patients with HF. AF = atrial fibrillation; BNP = B-type natriuretic peptide; HF = heart failure; LAD = left atrial dimeter; LVEF = left ventricular ejection fraction.