Cryoballoon Ablation for the Treatment of Atrial Fibrillation in Patients With Concomitant Heart Failure and Either Reduced or Preserved Left Ventricular Ejection Fraction: Results From the Cryo AF Global Registry

Figures

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  Figure 1. Baseline characteristics of the heart failure (HF) cohort. The HF cohort stratified by New York Heart Association (NYHA) class status and left ventricular ejection fraction (LVEF). Patients had an NYHA class of I to III, and most patients had preserved LVEF. EF indicates ejection fraction; HFmEF, HF with mild reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; and HFrEF, heart failure with reduced ejection fraction.

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  Figure 2. Freedom from atrial arrhythmia recurrence over 12 months. Kaplan–Maier estimate of 12‐month freedom from a ≥30‐second recurrence of atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) in patients with paroxysmal AF (blue) and persistent AF (red) with (dashed line) and without (solid line) heart failure (HF). Persistent AF at baseline predicted atrial arrhythmia recurrence (P<0.001), but HF status did not predict arrhythmia recurrence over the 12‐month follow‐up (P=0.319). PAF indicates paroxysmal atrial fibrillation; and PsAF, persistent atrial fibrillation.

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  Figure 3. Change in atrial fibrillation (AF)–related symptoms after cryoballoon ablation. A, The percentage of patients with heart failure (HF) and patients without HF with 0 (green), 1 (blue), 2 (yellow), and ≥3 AF‐related symptoms (red) at baseline and 12‐month follow‐up is depicted. AF‐related symptom burden was higher in the HF cohort at baseline, and AF symptom burden significantly reduced from baseline to 12 months in both the HF and no‐HF cohorts (P<0.001). B, AF‐related symptoms after cryoballoon ablation were significantly reduced between baseline and the 12‐month follow‐up (P<0.001 for all except syncope in the HF group, P=0.052).

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  Figure 4. Health care utilization after cryoballoon ablation. A, Antiarrhythmic drug utilization decreased between discharge (blue) and 12 months (yellow) among patient subgroups. B, Kaplan‐Meier estimate of freedom from reablation over 12 months is displayed. Persistent atrial fibrillation (AF), but not heart failure (HF) status (P=0.439), predicted reablation (P=0.001) over follow‐up. Kaplan–Meier estimates of (C) freedom from all‐cause and (D) cardiovascular‐related rehospitalization over 12‐month follow‐up are presented. HF predicted both all‐cause (P<0.001) and cardiovascular‐related (P<0.001) rehospitalization. Persistent AF did not predict all‐cause hospitalization (P=0.179) but did predict cardiovascular‐related rehospitalization (P=0.032) over follow‐up. AAD indicates antiarrhythmic drug; PAF, paroxysmal atrial fibrillation; and PsAF, persistent atrial fibrillation.