One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation

Abstract

AimsPulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences.Methods and resultsPatients with symptomatic AF despite anti-arrhythmic drugs (AADs) were treated with cryoballoon PVI. Daily transtelephonic ECG monitoring, 24 h Holter-ECG, and an arrhythmia-focused questionnaire were used to document AF. One hundred and forty-one patients completed a follow-up of 457 ± 252 days. Before ablation, Holter-ECG showed AF in 45%, including 16% continuous AF throughout the recording. Event recording revealed a median AF burden of 26%. The questionnaire showed a median of weekly AF complaints lasting for hours. All but one patient had successful PVI with a single procedure. After ablation, AF (defined as lasting for more than 30 s) was seen in 11% of Holter-ECGs, with 1% continuous AF. The event recording showed an AF burden of 9%. The median patient reported no more AF-related symptoms. Recurrence during the first 3 months was predictive for later recurrence. A second procedure was performed in 24 patients. The freedom of AF was 59% without AADs after 1,2 procedures. Four right phrenic nerve paralyses occurred, all resolving within 6 months. No PV stenoses were observed.ConclusionPulmonary vein isolation with a cryothermal balloon is an effective treatment for paroxysmal AF, resulting in a clinical success rate comparable to studies involving radiofrequency ablation. Temporary right phrenic nerve paralysis is the most important complication.

Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon

“…Cryoballoon ablation is safe, and has a similar success rate, when compared to RF ablation with comparable procedure and fluoroscopy times in patients suffering from PAF [4]. However, reported 1 year success rates are limited to 60-74% [5][6][7][8]. Therefore, the aim of this study is to identify the predictors of success specifically in patients undergoing cryoballoon ablation for PAF.…”

Incidence and Significance of Early Recurrences of Atrial Fibrillation After Cryoballoon Ablation

“…[3][4][5][6][7][8] Although studies have retrospectively examined clinical variables associated with early and late arrhythmic recurrence after radiofrequency ablation, there is limited evidence regarding the prognostic significance of ERAF after cryoballoon ablation. 6,9 Moreover, the effect of early reablation (ie, within the 3-month blanking period) in patients with early recurrences after cryoballoon ablation remains unknown.…”

Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?

“…Moreover, the combination of normal-sized LA and relatively big balloon may result not only in ostial circumferential but also in PVI by ipsilateral antral block ablation, which might further improve the clinical outcome [27]. Comparable good results in similar low risk patients, were recently showed by others [15,28]. Moreover, CBA procedure was proposed as first-line therapy in patients with lone paroxysmal AF [15].…”