Predictors of freedom from atrial arrhythmia recurrence after cryoballoon ablation for persistent atrial fibrillation: A multicenter study

Abstract

Aims We sought to assess (1) clinical outcomes of second‐generation cryoballoon (CB) ablation for persistent atrial fibrillation (AF), and (2) the association of baseline and procedural covariates with atrial arrhythmia recurrence (AAR) after ablation. Methods A total of 135 patients (63 ± 11 years, 96 men [71%]) with persistent AF underwent CB ablation at three experienced electrophysiology centers. Freedom from AAR was estimated with the Kaplan‐Meier method. A Cox proportional‐hazards model was used to estimate the effects of baseline and procedural covariates on the likelihood of AAR. Results Freedom from AAR at 6, 12, and 18 months was estimated at 91% (95% confidence interval [CI] 86%‐96%), 75% (95% CI, 67%‐83%), and 53% (95% CI, 43%‐65%), respectively. The presence of an implantable cardiac device (Hazard ratio [HR] 3.09; 95% CI, 1.37‐7.00; P = .007), a left atrial (LA) diameter > 50 mm (HR 1.69; 95% CI, 1.02‐2.79; P = .043), and absence of antiarrhythmic drug (AAD) therapy before the ablation procedure (HR 3.12; 95% CI, 1.72‐5.64; P < .001) were associated with AAR. A trend toward an increased risk of AAR was revealed for women (HR 1.73; 95% CI, 0.96‐3.11; P = .069). Conclusions CB ablation for persistent AF resulted in freedom from AAR about that reported for RF ablation. The presence of an implantable cardiac device, LA size, and absence of AAD therapy at baseline were associated with the risk of AAR.

Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

“…Left atrial diameter was a strong independent predictor of recurrence. This result proves the observation of Reissmann et al ( 17 ) and Akkaya et al ( 18 ) on a larger population.…”

“…Left atrial diameter was a strong independent predictor of recurrence. This result proves the observation of Reissmann et al (17) and Akkaya et al (18) on a larger population. Female sex was an independent predictor for atrial arrhythmia recurrence in our study.…”

“…In the 1STOP trial, with mainly patients with paroxysmal AF, female sex has also been reported to be an independent predictor for recurrence after CBA (20). Neither Reissmann nor Akkaya has found sex-related differences in CBA for persistent AF (17,18). However, both of the studies were smaller, with 135 and 102 patients, respectively.…”

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

“…LA diameter obtained from 2D echocardiographic images is a predictor of AF recurrence after cardioversion or catheter ablation, 19,20 and it is used in a number of scores to predict the presence of atrial substrate 12 . In particular, the DR‐FLASH score 21 (based on LA diameter >45 mm; age >65 years; female sex, persistent AF, diabetes mellitus, renal dysfunction, and hypertension) has been show to predict the presence of LVZs well.…”

Clinical outcomes of cryoballoon ablation for pulmonary vein isolation: Impact of intraprocedural heart rhythm

“…During this time, several predictors of freedom from recurrence of AF and permanent PVI have been identified. As such, the time to PVI (confirmed by real-time recordings), the thaw time, and the nadir temperature of the CB impact PVI durability [8,[14][15][16]. Each of these parameters represents a surrogate of the balloon-tissue contact and energy transfer, which is still the most relevant aspect in creating durable, transmural cryolesions.…”