Three-Year Clinical Outcome After 2nd-Generation Cryoballoon-Based Pulmonary Vein Isolation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation - A 2-Center Experience

BACKGROUND

Pulmonary vein isolation (PVI) using the 2nd-generation cryoballoon (CB2) for the treatment of atrial fibrillation (AF) has demonstrated encouraging acute and mid-term results. However, follow-up data on outcomes beyond 1 year are sparse. We investigated the 3-year outcome after PVI using the CB2.Methods and Results:100 patients with paroxysmal (PAF, 70/100 [70%] patients) or persistent AF (pAF, 30/100 [30%] patients) underwent CB2-based PVI in 2 experienced centers in Germany. Freeze-cycle duration was 240 s. After successful PVI a bonus freeze-cycle of the same duration was applied in the first 71 patients but was omitted in the following 29 patients. Phrenic nerve palsy occurred in 3 patients (3%); 2 patients were lost to follow-up. After a median follow-up of 38 (29-50) months, 59/98 (60.2%) patients remained in stable sinus rhythm (PAF: 48/70 (69%), pAF: 11/28 (39%) P=0.0084). In 32/39 (77%) patients with arrhythmia recurrence, a second ablation procedure using radiofrequency energy was conducted. Persistent PVI was noted in 76/125 (61%) PVs. After a mean of 1.37±0.6 procedures and a median follow-up of 35 (25-39) months, 77/98 (78.6%) patients remained in stable sinus rhythm (PAF: 56/70 (80%), pAF: 20/28 (71%), P=0.0276).

CONCLUSIONS

CB2-based PVI resulted in a 60.2% single-procedure and a 78.6% multiple-procedure success rate after 3 years. Repeat procedures demonstrated a high rate of durable PVI.

One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis

AIMS

The purpose of this study was to determine efficacy of pulmonary vein isolation (PVI) using the 28 mm cryoballoon (CB) in patients with persistent atrial fibrillation (AF). Superior acute and 1-year outcome has been demonstrated following PVI, using the second-generation CB in patients with paroxysmal AF. Data on the outcome in patients with persistent AF are sparse.

METHODS AND RESULTS

Forty-nine patients (20 female, mean age 63 ± 10 years, mean left atrial diameter 46 ± 5 mm) with persistent AF [median AF duration since first diagnosis: 48 (20:192) months] underwent second-generation 28 mm CB-based PVI. The freeze cycle duration was set at 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 11/49 (22%) patients, and no bonus freeze cycle was used in the remaining 38/49 (78%) patients. Follow-up (FU) was based on outpatient clinic visits at 3, 6, and 12 months, which included Holter electrocardiograms and telephone interviews. Recurrence was defined as an episode of symptomatic and/or documented atrial tachyarrhythmia >30 s beyond the 3-month blanking period. A total of 193 pulmonary veins (PVs) were identified and 193/193 (100%) PVs were successfully isolated. No phrenic nerve paralysis occurred. Follow-up was obtained in 49/49 (100%) patients with a mean FU duration of 416 ± 178 days. After the 3-month blanking period, antiarrhythmic medication was discontinued in 33/49 (67%) patients. Thirty-four of 49 (69%) patients remained in stable sinus rhythm.

CONCLUSIONS

In patients with persistent AF, use of the second-generation 28 mm CB was associated with a 69% 1-year clinical success rate.

One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Background—

The use of second-generation cryoballoon for pulmonary vein isolation in patients with paroxysmal atrial fibrillation has demonstrated encouraging acute and mid-term results. Long-term outcome data are not yet available.

Methods and Results—

Fifty patients (18 women; mean age, 61±11 years; mean left atrial diameter, 43±5 mm) with paroxysmal (36 of 50 patients; 72%) or short-standing (<3-month duration) persistent atrial fibrillation (14 of 50 patients; 28%) underwent cryoballoon-based pulmonary vein isolation. Freeze cycle duration was 240 seconds. After successful pulmonary vein isolation, a bonus freeze was applied. Follow-up was based on outpatient clinic visits at 3, 6, and 12 months including Holter-ECGs and telephonic interviews. Recurrence was defined as a symptomatic or documented arrhythmia episode >30 seconds excluding a 3-month blanking period. A total of 192 pulmonary veins were identified, and 191 of 192 (99%) pulmonary veins were successfully isolated. Phrenic nerve palsy occurred in 1 of 50 (2%) patients. Follow-up was available for 49 of 50 (98%) patients with a mean follow-up duration of 440±39 days. Thirty-nine of 49 (80%) patients remained in stable sinus rhythm. Of 8 of 10 patients with arrhythmia recurrence, a second procedure using radiofrequency ablation demonstrated left atrial to pulmonary vein reconduction.

Conclusions—

The use of second-generation 28-mm cryoballoon for pulmonary vein isolation results in an 80% 1-year success rate.