Cryoballoon Ablation for the Treatment of Atrial Fibrillation in Patients With Concomitant Heart Failure and Either Reduced or Preserved Left Ventricular Ejection Fraction: Results From the Cryo AF Global Registry

Abstract

Background Heart failure (HF) and atrial fibrillation (AF) often coexist; yet, outcomes of ablation in patients with AF and concomitant HF are limited. This analysis assessed outcomes of cryoablation in patients with AF and HF. Methods and Results The Cryo AF Global Registry is a prospective, multicenter registry of patients with AF who were treated with cryoballoon ablation according to routine practice at 56 sites in 26 countries. Patients with baseline New York Heart Association class I to III (HF cohort) were compared with patients without HF. Freedom from atrial arrhythmia recurrence ≥30 seconds, safety, and health care utilization over 12‐month follow‐up were analyzed. A total of 1303 patients (318 HF) were included. Patients with HF commonly had preserved left ventricular ejection fraction (81.6%), were more often women (45.6% versus 33.6%) with persistent AF (25.8% versus 14.3%), and had a larger left atrial diameter (4.4±0.9 versus 4.0±0.7 cm). Serious procedure‐related complications occurred in 4.1% of patients with HF and 2.6% of patients without HF ( P =0.188). Freedom from atrial arrhythmia recurrence was not different between cohorts with either paroxysmal AF (84.2% [95% CI, 78.6–88.4] versus 86.8% [95% CI, 84.2–89.0]) or persistent AF (69.6% [95% CI, 58.1–78.5] versus 71.8% [95% CI, 63.2–78.7]) ( P =0.319). After ablation, a reduction in AF‐related symptoms and antiarrhythmic drug use was observed in both cohorts (HF and no‐HF), and freedom from repeat ablation was not different between cohorts. Persistent AF and HF predicted a post‐ablation cardiovascular rehospitalization ( P =0.032 and P =0.001, respectively). Conclusions Cryoablation to treat patients with AF is similarly effective at 12 months in patients with and without HF. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02752737.

Efficacy and feasibility of cryoballoon ablation for atrial fibrillation in patients with heart failure: A large‐scale multicenter study

“…The LVEF groups of HF patients were stratified based on the LVEF determined on echocardiography before the procedure time, and the value of LVEF might have changed according to recent HF onset and management thereafter. The rate of touch‐up ablation for PV isolation was relatively higher than those of most recent publications, representing nearly a 100% success rate of cryoballoon ablation alone 11 . Due to the educational and training aspects of most institutions in the present study, clinical fellows and young doctors preferentially performed cryoballoon ablation because of its simplicity, which may be responsible for the decreased acute success rate.…”

“…[8][9][10] In this context, a patients with PAF or persistent AF. 11 Our study follows their outcomes by including a greater number of HF patients (n = 549) and a longer follow-up period (>2 years) than that (12 months) in the previous study. Detailed analyses stratifying AF type in the HF group showed a similar rate of recurrence without increased major complications after ablation compared to those in previous studies, 10,11 supporting the feasibility and safety of cryoballoon ablation for HF patients with PAF as well as persistent AF.…”

“…The study did not include non‐HF patients undergoing cryoballoon ablation or a comparable group of those HF patients undergoing radiofrequency ablation for AF or a medication‐only group 23,24 . The study did not assess symptom recovery, NYHA class, or quality of life after the follow‐up period 11 . The LVEF groups of HF patients were stratified based on the LVEF determined on echocardiography before the procedure time, and the value of LVEF might have changed according to recent HF onset and management thereafter.…”

“…However, few reports evaluated the outcomes of cryoballoon ablation for AF in small sample sizes of patients with HF, especially those with HFrEF 8–10 . In this context, a recent large‐scale study from the Cryo AF Global Registry of 318 HF patients demonstrated similar efficacy and prognosis during 12‐month follow‐up after cryoablation between HF and non‐HF patients with PAF or persistent AF 11 . Our study follows their outcomes by including a greater number of HF patients ( n = 549) and a longer follow‐up period (>2 years) than that (12 months) in the previous study.…”

“…Cryoballoon ablation for AF has evolved to be highly efficacious and less invasive, and it is currently performed worldwide in clinical practice 7 . The cryoballoon‐based approach is a potential treatment for patients with HF based on its shorter procedure time and simple technique; however, few data with small sample sizes evaluate the efficacy and clinical outcomes of cryoballoon ablation for AF in patients with HF 8–11 …”