Early reablation for early recurrence of atrial fibrillation after cryoballoon ablation significantly reduced late recurrence compared to no early reablation (3.3% vs 55.6%; HR 0.04; P=0.002).
RCT (n=245)
randomized
Does early reablation prevent late recurrence of atrial fibrillation in patients with early recurrence after cryoballoon ablation?
Early recurrence of AF after cryoballoon ablation is common and strongly predicts late recurrence, but early reablation is associated with significantly improved long-term freedom from AF.
Hazard Ratio: 0.04 (95% CI 0.01–0.32)
Absolute Event Rate: 3.3% vs 55.6%
p-value: p=0.002
BACKGROUND: Early recurrence of atrial fibrillation (ERAF) is common after radiofrequency catheter ablation for AF. We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation. Moreover, the benefit of early reablation for ERAF after cryoballoon ablation is undetermined. METHODS AND RESULTS: The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) trial randomized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation. Patients were followed for 12 months. ERAF was defined as any recurrence of AF >30 seconds during the first 3 months of follow-up. Late recurrence (LR) was defined as any recurrence of AF >30 seconds between 3 and 12 months. Of the 163 patients randomized to cryoablation, 84 patients experienced ERAF (51.5%). The only significant factor associated with ERAF was male sex (hazard ratio HR, 2.18; 95% confidence interval CI, 1.03-4.61; P=0.041). LR was observed in 41 patients (25.1%), and was significantly related to ERAF (55.6% LR with ERAF versus 12.7% without ERAF; P<0.001). Among patients with ERAF, only current tobacco use (HR, 3.84; 95% CI, 1.82-8.11; P<0.001) was associated with LR. Conversely, early reablation was associated with greater freedom from LR (3.3% LR with early reablation versus 55.6% without; HR, 0.04; 95% CI, 0.01-0.32; P=0.002). CONCLUSIONS: ERAF after cryoballoon ablation occurs in ≈50% of patients and is strongly associated with LR. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF.
Andrade et al. (Tue,) conducted a rct in Paroxysmal Atrial Fibrillation (n=245). Early reablation vs. No early reablation was evaluated on Late recurrence (LR) of AF (>30 seconds between 3 and 12 months) (HR 0.04, 95% CI 0.01-0.32, p=0.002). Early reablation for early recurrence of atrial fibrillation after cryoballoon ablation significantly reduced late recurrence compared to no early reablation (3.3% vs 55.6%; HR 0.04; P=0.002).