Long-Term Clinical Outcomes Following Cryoballoon Ablation in Patients with Paroxysmal Atrial Fibrillation: Single-Center Experience

Abstract

Objective: Atrial fibrillation (AF) is a prevalent arrhythmia, often managed with pulmonary vein isolation (PVI) using cryoballoon ablation, particularly in symptomatic patients. This retrospective single-center study aimed to evaluate the long-term outcomes and influencing factors of cryoballoon-based PVIs. Materials and Methods:Seventy-four patients diagnosed with paroxysmal AF, symptomatic despite medical therapy, underwent successful cryoballoon PVI between January 2012 and August 2022. Patients were monitored for AF recurrence via ECG and Holter follow-ups. Recurrence rates were compared between groups based on various demographic, echocardiographic, biochemical, and procedural parameters.Results: A median follow-up of 27 (14.5) months revealed AF recurrence in 50% of patients. Recurrence rates at 1, 3, and 5 years were 23%, 44%, and 51.4%, respectively. Factors significantly associated with recurrence included low hemoglobin and potassium levels, enlarged left atrial diameter, mitral valve abnormalities, and elevated estimated pulmonary artery pressure. Multivariate Cox regression analysis identified left atrial diameter as an independent predictor of recurrence (HR=1.130, 95% CI: 1.010-1.285, p=0.034). A receiver operating characteristic curve was drawn and a cut-off value of 39.5 mm was determined for the left atrium using the Youden index (AUC: 0.747, 95% CI: 0.636-0.859, p<0.001). This cut-off value predicted AF recurrence with 64.9% sensitivity, 70.3% specification. Conclusion:This study confirms existing literature on cryoballoon PVI outcomes. Left atrial diameter emerges as a significant independent predictor of AF recurrence, highlighting its importance in assessing patient and procedural parameters.