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. 2024 Sep;67(6):1407-1417.
doi: 10.1007/s10840-024-01752-8. Epub 2024 Jan 23.

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

Andrija Nekić  1 , Ivan Prepolec  2 , Vedran Pašara  2 , Jakov Emanuel Bogdanić  1 , Jurica Putrić Posavec  1 , Domagoj Kardum  2 , Zvonimir Katić  2 , Andrija Štajduhar  1 , Borka Pezo Nikolić  2 , Davor Puljević  2 , Davor Miličić  1   2 , G B Chierchia  3 , Carlo de Asmundis  3 , Vedran Velagić  4   5
Affiliations

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

Andrija Nekić et al. J Interv Card Electrophysiol. 2024 Sep.

Abstract

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.

Keywords: Atrial fibrillation; Catheter ablation; Cryoballoon; Long-term follow-up.

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