Treatment of atrial fibrillation with second-generation cryoballoon followed by contact-sensing radiofrequency catheter ablation for arrhythmia recurrences—results of a 5-year follow-up

• Published in: Journal of interventional cardiac electrophysiology 2024-09, Vol.67 (6), p.1407-1417
• Main Authors: Nekić, Andrija, Prepolec, Ivan, Pašara, Vedran, Bogdanić, Jakov Emanuel, Posavec, Jurica Putrić, Kardum, Domagoj, Katić, Zvonimir, Štajduhar, Andrija, Nikolić, Borka Pezo, Puljević, Davor, Miličić, Davor, Chierchia, G. B., de Asmundis, Carlo, Velagić, Vedran
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Antiarrhythmics; Arrhythmia; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiology; Catheter Ablation - methods; Catheters; Complications; Cryosurgery - methods; Drugs; Female; Fibrillation; Follow-Up Studies; Humans; Male; Medical instruments; Medicine; Medicine & Public Health; Middle Aged; Pseudoaneurysm; Pulmonary Veins - surgery; Radio frequency; Recurrence; Reoperation; Retrospective Studies; Statistical analysis; Treatment Outcome; Veins
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-024-01752-8

Introduction The aim of this study was to report the long-term follow-up results of cryoballoon (CB) ablation in patients with atrial fibrillation. Methods All consecutive patients who underwent second-generation CB ablation from February 2015 to December 2017 were included in our study. In all procedures, we used a 28-mm CB placed via a single transseptal puncture guided by intracardiac ultrasound. A 20-mm octapolar intraluminal circular catheter was used for intracardiac recordings. A single 180-s freeze strategy was employed. Repeated procedures were performed with a 3D mapping system and radiofrequency catheters. Results A total of 126 patients (69.8% male, mean age 57 ± 11 years), of which 77.0% had paroxysmal atrial fibrillation (PAF), were included in the study. After a 5-year period, 52.4% of patients were in sinus rhythm without AF recurrence, off antiarrhythmic drugs. A total of 61.9% of patients were free of AF recurrence when redo PVI procedures were performed. When accounting for redo pulmonary vein isolation and antiarrhythmic drugs, a total of 73.8% of the patients were without AF recurrence in long-term follow-up. The patients who underwent redo pulmonary vein isolation procedures had statistically significant lower rates of AF recurrence ( p  = 0.006). In patients with PAF, long-term success rates improved from 62.9 to 79.4% for patients who underwent the redo procedure ( p  = 0.020). In patients with persistent atrial fibrillation (PersAF), success rates went up from 41.4 to 55.1% for patients with single or repeated PVI procedure ( p  = 0.071). In the whole cohort, a total of 3 (2.4%) procedure-related major complications occurred which included persistent PNP, arterial pseudoaneurysm, and arteriovenous fistula. Conclusion Our data suggest a favorable long-term safety and efficacy profile of second-generation CB ablation. In the mixed paroxysmal and persistent population, up to 73.8% of patients remained free of AF recurrence in the 5-year follow-up, when accounting for redo procedures and AADs. Only 2.4% of patients experienced major complications of the ablation procedure, none with permanent sequelae. Graphical Abstract Central figure. K-M curves for overall population