Predictors of Arrhythmia Recurrence After Cryoballoon Ablation for Persistent Atrial Fibrillation: A Sub-Analysis of the Cryo Global Registry

Abstract

Introduction

Freedom from recurrences of atrial tachyarrhythmia (ATA) is suboptimal after pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (PsAF). This sub-analysis from the Cryo Global Registry sought to investigate predictors of ablation success after PVI using cryoballoon ablation (CBA) for PsAF.

Methods and Results

ATA recurrence was defined as ≥ 30 s recurrence of atrial fibrillation, atrial flutter or atrial tachycardia after a 90-day blanking period and through 12-months. Univariate and multivariable Cox regression analysis (with ATA recurrence as an endpoint) was performed to identify CBA responders. PsAF patients (N = 882) were on average 63.9 ± 11.3 years old (69.2% male), and freedom from ATA recurrence was 79.7% (76.8%–82.2%). Longer elapsed time from PsAF diagnosis to ablation (hazard ratio [HR] 1.07 (95% confidence interval [CI]: 1.03–1.11); p = 0.002) and a larger number of previously failed antiarrhythmic drugs (HR 1.39 (95% CI: 1.13–1.70); p < 0.002) were shown to be independent predictors of ATA recurrence in a multivariate model which included 703 evaluated patients.

Conclusion

These real-world results provide important insights to guide referral of PsAF patients, including the benefits of earlier treatment via CBA.