Durable burden suppression and recurrence patterns after cryoablation in early persistent AF: 3-year results of...

Long-term rhythm outcomes following cryoballoon ablation (CBA) in early persistent atrial fibrillation (AF) remain incompletely characterized.

To evaluate 3-year atrial fibrillation (AF) burden trajectories, subsequent recurrence patterns detected by implantable loop recorder (ILR), and their association with healthcare resource utilization (HCRU).

The COOL-PER trial was a prospective, multicenter, single-arm study that enrolled patients with early persistent AF (duration ≤ 3 years). An ILR was implanted 7-90 days before CBA for continuous rhythm monitoring.

Among 130 enrolled patients, 123 completed the 3-year follow-up (mean age, 60.5 ± 8.4 years; 25.2% women). Median AF burden decreased from 99.9% (interquartile range, 53.1-100.0) at baseline to 0.1% (0.0-4.2), 0.5% (0.0-9.1), and 0.7% (0.0-9.5) at 1, 2, and 3 years (all P < .001). Of 47 patients who were recurrence-free at 1 year, 25 (53.2%) developed subsequent recurrence, and 20 (80.0%) were detected by ILR alone. Compared with first-year recurrence, subsequent recurrence was less often persistent (4.0% vs 28.9%; P = .001) and was associated with a lower AF burden (0.1% [0.0-1.6] vs 2.8% [0.4-18.7]; P = .010). Both persistent-type recurrence and AF burden ≥ 10% were associated with more additional rhythm control interventions (78.3% vs 30.8% vs 0%; 78.6% vs 39.1% vs 0%; both P < .001) and cardiovascular hospitalization (17.4% vs 3.8% vs 0%, P = .045; 14.3% vs 4.3% vs 0%, P = .029).

CBA achieved durable AF burden suppression over 3 years in early persistent AF. Subsequent recurrence after the first year was common and was predominantly detectable by ILR only. Subsequent recurrences were often paroxysmal, with a lower AF burden and associated with lower HCRU, supporting the value of continuous long-term rhythm monitoring for characterizing rhythm status beyond the first post-ablation year.