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. 2022 Feb 22;11(5):1166.
doi: 10.3390/jcm11051166.

Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA)

Ermengol Vallès  1 , Jesús Jiménez  1 , Julio Martí-Almor  1 , Jorge Toquero  2 , José Miguel Ormaetxe  3 , Alberto Barrera  4 , Arcadio García-Alberola  5 , José Manuel Rubio  6 , Pablo Moriña  7 , Carlos Grande  8 , Maria Fé Arcocha  9 , Rafael Peinado  10 , Rocío Cózar  11 , Julio Hernández  12 , Luisa Pérez-Alvarez  13 , Larraitz Gaztañaga  3   14 , Angel Ferrero-De Loma-Osorio  15 , Ricardo Ruiz-Granell  15 , Roger Villuendas  16 , Jesús Daniel Martínez-Alday  3   14
Affiliations

Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA)

Ermengol Vallès et al. J Clin Med. .

Abstract

Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8 ± 10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs. 11.4%; p < 0.001) and left atrium dilation (72.6 vs. 43.3%; p < 0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs. 22.2%; p < 0.001), with an arterial line (32.2 vs. 44.6%; p < 0.001) and assisted transeptal puncture (11.9 vs. 17.9%; p = 0.025). During an application, PeAF patients had a longer time to −30 °C (35.91 ± 14.20 vs. 34.93 ± 12.87 s; p = 0.021) and a colder balloon nadir temperature during vein isolation (−35.04 ± 9.58 vs. −33.61 ± 10.32 °C; p = 0.004), but received fewer bonus freeze applications (30.7 vs. 41.1%; p < 0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p = 0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.

Keywords: cryoballoon procedure; persistent atrial fibrillation; registry.

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Conflict of interest statement

Dr. Toquero is member of the Medtronic European advisory board. Dr. Toquero, Dr. Villuendas and Dr. Cozar have received speaker honorarium from Medtronic. Dr. Peinado has received a research and training grant from Medtronic. Dr. Toquero and Dr. García-Alberola have received educational grant from Medtronic. Dr. Martinez-Alday has received speaker honorarium from Medtronic, Boston and Abbott. Dr. Ferrero has received speaker honorarium from Medtronic and Boston. Dr. Ferrero has received speaker honorarium from Medtronic and Boston.

Figures

Figure 1
Figure 1
Recurrences Kaplan-Meier survival analyses. PaAF patients had a higher percentage of freedom from AF recurrence than PeAF patients at 15 months (78.9% vs. 70.9%, respectively). The curves show significant differences (p = 0.015), which are more accentuated after 10 months.
See this image and copyright information in PMC

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