Cryoballoon ablation for paroxysmal atrial fibrillation achieved a 5-year success rate of 53%, with normalized left atrium ≥10.25 being the sole independent predictor of recurrence (HR 2.11).
Cohort (n=163)
No
Does pulmonary vein isolation using cryoballoon ablation prevent recurrence of atrial arrhythmias in patients with symptomatic, drug-refractory paroxysmal atrial fibrillation over 5 years?
A single cryoballoon ablation procedure maintains sinus rhythm at 5 years in 53% of patients with drug-refractory paroxysmal AF, with enlarged left atrium predicting higher recurrence.
AIMS: Long-term efficacy following cryoballoon (CB) ablation of atrial fibrillation (AF) remains unknown. This study describes 5 years follow-up results and predictors of success of CB ablation in patients with paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: In total, 163 patients were enrolled with symptomatic, drug refractory PAF. Pulmonary vein isolation (PVI) with CB technique was performed. Primary endpoint of this consecutive single-centre study was first electrocardiogram-documented recurrence of AF, atrial tachycardia or atrial flutter (AFLAT). Five years success rate after single CB ablation was 53%. In 70% of the patients acute complete PVI was achieved with a single 28 mm balloon. The univariate predictors of AFLAT recurrence were (1) size of left atrium, with normalized left atrium (NLA) ≥10.25 hazard ratios (HR) of 1.81, 95% confidence interval (CI): 1.28-2.56 when compared with NLA <10.25 (35% vs. 53%, P = 0.0001) and (2) renal function, with impaired glomerular filtration rate (GFR) <80 ml/min (HR of 1.26, 95% CI: 1.02-1.57) when compared with GFR ≥80 ml/min (45% vs. 53%, P = 0.041). Normalized left atrium ≥10.25 was the sole independent predictor for outcome (HR 2.11; 95% CI: 1.34-3.31; P = 0.0001). CONCLUSIONS: Sinus rhythm can be maintained in a substantial proportion of patients with PAF even 5 years after circumferential PVI using CB ablation. The rate of decline in freedom from AFLAT was highest within the first 12 months after the index procedure. The patients with enlarged left atrium and/or impaired renal function have lower outcome.
Neumann et al. (2013) conducted a cohort in paroxysmal atrial fibrillation (PAF) (n=163). Cryoballoon (CB) ablation was evaluated on first electrocardiogram-documented recurrence of AF, atrial tachycardia or atrial flutter (AFLAT). Cryoballoon ablation for paroxysmal atrial fibrillation achieved a 5-year success rate of 53%, with normalized left atrium ≥10.25 being the sole independent predictor of recurrence (HR 2.11).