Efficacy of second-generation cryoballoon ablation in paroxysmal and persistent atrial fibrillation patients

Aims In this study, we aimed to compare the efficacy of single pulmonary vein isolation with the second-generation cryoballoon (CB-Adv) and predictors of atrial fibrillation recurrences in patients with paroxysmal (PAF) and persistent atrial fibrillation (PersAF). Methods Consecutive PAF and PersAF patients undergoing CB-Adv for the first time were enrolled. Patients were followed with in-clinic visits including Holter ECG. Atrial arrhythmic episodes symptomatic or documented lasting more than 30s were considered as recurrences. Results A total of 96 consecutive patients [77 men (80%), mean age 57.4±9.9 years] were included in this analysis. About 56 (58%) patients had PAF and 40 had (42%) PersAF. The mean procedural and fluoroscopy times were 116±24 and 33±12min, respectively. Procedure-related complications occurred in four (4.2%) patients. At the 12-month follow-up, after a 3-month blanking period, freedom from recurrences was achieved in 59% [confidence interval (CI): 49-69%] of patients, 62% (CI: 48-75%) in PAF, and 54% (CI: 38-71%) in PersAF group. The difference was not statistically significant at the Kaplan-Meier survival analysis (P=0.242). Cardioversion to restore sinus rhythm was less frequently needed in PAF group [5% (CI: 1-15%) vs. 25% (CI: 13-41%), P<0.001]. Redo procedure was performed in 7% (CI: 3-15%) of patients. In the Cox regression analysis, early atrial-tachyarrhythmia recurrence was the only independent predictor of 1-year recurrence (hazard ratio 2.11, CI: 1.06-4.20, P=0.03). Conclusion The success rate at 12 months after a single CB-Adv procedure was 62% in patients with PAF and 54% in study participants with PersAF. Early atrial-tachyarrhythmia recurrence appeared to be the only independent predictor of late atrial fibrillation recurrence.