Abstract
Objective
Cryoballoon ablation (CBA) has emerged as an effective and safe treatment option in atrial fibrillation (AF). This study aimed to evaluate the long-term outcomes of patients undergoing CBA in our clinic.
Material and Methods
In this retrospective, single-center study, 153 patients who underwent successful CBA for symptomatic AF between 2012 and 2016 were included. Demographic, clinical, and echocardiographic data were collected. All patients were followed for a mean of 1184 days (745-1746 days) with scheduled electrocardiography, Holter, and clinical visits. Predictors of recurrence were analyzed using univariate and multivariate logistic regression.
Results
Of the study population, 38% were female, with a mean age of 52.4±10.9 years. Mean procedure and fluoroscopy times were 69.5±1.7 min and 12.8±0.8 min, respectively. During follow-up, recurrence occurred in 39 patients (25.4%). Recurrence was significantly associated with female sex (p=0.001), older age (p=0.035), larger left atrial diameter (p<0.001), and persistent AF (p=0.003). In multivariate analysis, left atrial diameter (p=0.023) and persistent AF (p=0.014) were identified as independent predictors. The complication rate was low, and no severe disabling events occurred.
Conclusion
CBA is an effective and safe therapeutic option for maintaining sinus rhythm in AF patients. Persistent AF and increased left atrial size are independent predictors of long-term recurrence.
Keywords: Atrial fibrillation, cryoballoon ablation, recurrence, long-term follow-up
References
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-2962.
Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al.; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-2747. Erratum in: Eur Heart J. 2013;34(10):790. Erratum in: Eur Heart J. 2013;34(36):2850-2851.
Wattigney WA, Mensah GA, Croft JB. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation. 2003;108(6):711-716.
Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997;96(7):2455-2461.
Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al.; CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417-427.
Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, et al.; STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013;61(16):1713-1723.
Vogt J, Heintze J, Gutleben KJ, Muntean B, Horstkotte D, Nölker G. Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol. 2013;61(16):1707-1712.
Andrade JG, Khairy P, Macle L, Packer DL, Lehmann JW, Holcomb RG, et al. Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial. Circ Arrhythm Electrophysiol. 2014;7(1):69-75.
Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4):528-606.
Özcan EE. Atriyal fibrilasyon kateter ablasyonu. Turkiye Klinikleri Cardiology-Special Topics. 2015;8(1):43-51.
Davies AJ, Jackson N, Barlow M, Leitch J. Long term follow-up of pulmonary vein isolation using cryoballoon ablation. Heart Lung Circ. 2016;25(3):290-295.
Bohó A, Mišíková S, Spurný P, Komanová E, Kerekanič M, Hudák M, et al. A long-term evaluation of cryoballoon ablation in 205 atrial fibrillation patients: a single center experience. Wien Klin Wochenschr. 2015;127(19-20):779-785.
Giovanni GD, Wauters K, Chierchia GB, Sieira J, Levinstein M, Conte G, et al. One-year follow-up after single procedure cryoballoon ablation: a comparison between the first and second generation balloon. J Cardiovasc Electrophysiol. 2014;25(8):834-839.
Efremidis M, Letsas KP, Georgopoulos S, Karamichalakis N, Vlachos K, Lioni L, et al. Safety, long-term outcomes and predictors of recurrence following a single catheter ablation procedure for atrial fibrillation. Acta Cardiol. 2019;74(4):319-324.
Quan D, Huang H, Kong B, Li Q, Liao J, Wang G. Predictors of late atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation: a meta-analysis. Kardiol Pol. 2017;75(4):376-385.
Evranos B, Aytemir K, Oto A, Okutucu S, Karakulak U, Şahiner L, et al. Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon. Cardiol J. 2013;20(3):294-303.
Akkaya E, Berkowitsch A, Zaltsberg S, Greiss H, Hamm CW, Sperzel J, et al. Five-year outcome and predictors of success after second-generation cryoballoon ablation for treatment of symptomatic atrial fibrillation. Int J Cardiol. 2018;266:106-111.
Huang SW, Jin Q, Zhang N, Ling TY, Pan WQ, Lin CJ, et al. Impact of pulmonary vein anatomy on long-term outcome of cryoballoon ablation for atrial fibrillation. Curr Med Sci. 2018;38(2):259-267.
Landolina M, Arena G, Iacopino S, Verlato R, Pieragnoli P, Curnis A, et al. Center experience does not influence long-term outcome and peri-procedural complications after cryoballoon ablation of paroxysmal atrial fibrillation: data on 860 patients from the real-world multicenter observational project. Int J Cardiol. 2018;272:130-136.
