Predictive value of early AF recurrence after cryoballoon ablation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Early recurrence of atrial fibrillation (ERAF) during a blanking period of 90 days after radiofrequency ablation has been associated with worse long-term outcome. However, the impact of ERAF after cryoballoon pulmonary vein isolation (cryoPVI) is less clear. Objective A prospective comparison of long-term ablation success after cryoPVI between patients who had ERAF during the blanking period and patients who remained free of AF recurrence during this period. Methods We analyzed consecutive patients who underwent cryoPVI in a single-center cohort between 2018 and 2020. Follow-up was performed at 3, 6, 12, 18 and 24 months after ablation. Primary endpoints were: symptomatic AF recurrence after a 90-day blanking period for efficacy and bleeding, phrenic nerve injury, stroke or death for safety. Results 472 consecutive patients with paroxysmal or persistent AF who underwent cryoPVI in a single-center cohort were analyzed. Mean follow-up time was 15 months. 64 patients presented with ERAF during blanking period (age 70 ± 8 years, 52% male gender, CHA2DS2-VASc 2.9 ± 1.5) while 408 patients demonstrated freedom from AF within the first 90 days after cryoPVI (age 69 ± 10 years, 57% male gender, CHA2DS2-VASc 2.7 ± 1.4). At 24 months, Kaplan-Meier estimates showed a significantly higher AF recurrence in patients with ERAF compared to patients without ERAF (74.6 % vs. 33.3%, P < 0.0001, Figure). Cox-regression analysis confirmed ERAF as independent predictor of impaired long-term ablation success after cryoPVI for both paroxysmal and persistent AF (P < 0.0001). Primary safety endpoint occurred in form of pericardial effusion or transient phrenic nerve palsy in one patient with ERAF (1.5%) and five patients without ERAF (1.2%). No deaths or strokes were observed. Conclusion ERAF during blanking period predicts long-term sucess of patients undergoing cryoPVI. Prospective studies addressing outcome optimisation in this particular cohort of patients are needed. Abstract Figure.