Incidence and Predictors of Very Late Recurrence of Atrial Fibrillation Following Cryoballoon Pulmonary Vein Isolation

Abstract

Background - A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when the first recurrence of AF occurs ≥ 12 months following ablation. Prior studies characterizing VLR have not used an implantable loop recorder (ILR) for ECG monitoring. Thus, it is unknown whether VLR truly occurs or whether these patients have simply had unrecognized AF. Our objective was to assess the incidence and predictors of VLR in patients who underwent cryoballoon (CB) pulmonary vein isolation (PVI) alone, had an ILR, and were confirmed AF-free for at least 1 year. Methods - We enrolled consecutive patients with paroxysmal or persistent AF who underwent CB PVI and had an ILR implanted < 3 months post-ablation. Patients free of AF 1-year post-ablation were followed prospectively for recurrent AF. All AF episodes were adjudicated. Results - We included 188 patients (66 ± 10 years; 116 [62%] male; 102 (54%) paroxysmal AF; CHA 2 DS 2 -VASc 2.6 ± 1.7). After 1-year post-PVI, 93 (49%) patients remained AF free. During subsequent follow-up, 30 (32%) patients had VLR of AF. The only independent risk factor for VLR was an elevated CHA 2 DS 2 -VASc score (HR 1.317 [95% CI: 1.033-1.6979], p=0.026). Patients with CHA2DS2-VASc score ≥ 4 represented a quarter of the population and were at highest risk. Conclusions - Our data using ILRs for continuous ECG monitoring post AF ablation show that VLR occurs in a third of patients after an apparently successful CB PVI procedure. Additional strategies are needed to ensure long-term freedom from AF recurrences in these high-risk patients.

Impact of left atrial low‐voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation

“…We studied a larger number of patients than previously reported, included intra procedural electrophysiological findings, and examined predictors of VLRAF. Although this is the first report on the association between LVAs and VLRAF, we consider that our results are consistent with previous findings to date, given that hypertension and diabetes, whose association with VLRAF is known, are also reported to be predictors of LVAs 27–29 …”

“…Although this is the first report on the association between LVAs and VLRAF, we consider that our results are consistent with previous findings to date, given that hypertension and diabetes, whose association with VLRAF is known, are also reported to be predictors of LVAs. [27][28][29]…”

Early rhythm‐control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry

“…21 Comorbidities and hypertension are associated with late recurrences of AF, that is, over 1 year after ablation. [22][23] Multiple comorbidities (CHA 2 DS 2 -VASc >2) have been seen to correlate with an increased degree of left atrial fibrosis, which has been found to be a predictor of AF after ablation. 24 These results suggest that recurrences in these patients could be associated with atrial remodeling.…”