Cryoballoon ablation for persistent atrial fibrillation - Large single-center experience

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Established catheter ablation (CA) strategies exist for persistent atrial fibrillation (persAF).
• Pulmonary vein isolation (PVI) alone is a potential initial ablation strategy.
• Limited outcome data exists for second-generation cryoballoon (CBG2) PVI in persAF.

Purpose of the Study:

• To evaluate the efficacy and safety of CBG2 PVI as an initial treatment for symptomatic, drug-refractory persAF.
• To assess the rate of freedom from AF, atrial tachycardia, or related symptoms post-procedure.
• To determine the incidence of periprocedural complications.

Main Methods:

• Prospective enrollment of patients with symptomatic drug-refractory persAF undergoing initial CA.
• Pulmonary vein isolation (PVI) performed using the second-generation cryoballoon (CBG2).
• Primary endpoint: freedom from AF/atrial tachycardia/related symptoms after a 3-month blanking period. Secondary endpoint: periprocedural complications.

Main Results:

• 173 patients with symptomatic drug-refractory persAF were included.
• 100% acute PVI success with CBG2; procedure time 112±30 min.
• Major complications in 1.7% (2 phrenic nerve palsies, 1 pericardial effusion), all resolved.
• At 12 months (157 patients, 91% follow-up), 82% achieved the primary endpoint.
• AF recurrence predictor: relapse during the blanking period.

Conclusions:

• Second-generation cryoballoon PVI is a reasonable option for symptomatic drug-refractory persAF.
• Achieved a favorable rate of freedom from AF and a low complication rate.
• Supports PVI with CBG2 as an effective initial treatment strategy.