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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

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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 map** 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.

Graphical Abstract

Central figure. K-M curves for overall population

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Authors and Affiliations

  1. School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia

    Andrija Nekić, Jakov Emanuel Bogdanić, Jurica Putrić Posavec, Andrija Štajduhar, Davor Miličić & Vedran Velagić

  2. Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Ivan Prepolec, Vedran Pašara, Domagoj Kardum, Zvonimir Katić, Borka Pezo Nikolić, Davor Puljević, Davor Miličić & Vedran Velagić

  3. Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium

    G. B. Chierchia & Carlo de Asmundis

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  1. Andrija Nekić
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Contributions

AN and VV were responsible for conception of the study and drafting of the manuscript. VP, IP, BPN, JEB, JPP, DK, ZK, and AS were responsible for acquisition and analysis of the data. DP, CdA, GBC, and DM were responsible for critical revision of the manuscript and important intellectual content.

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Correspondence to Vedran Velagić.

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Ethics approval

Ethical approval was waived by the local Ethics Committee of University Hospital Centre Zagreb in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The protocol was carried out in accordance with the ethical principles for medical research involving human subjects established by Helsinki’s declaration, protecting the privacy of all the participants as well as the confidentiality of their personal information.

Conflict of interest

VV received proctoring and lecture fees from Medtronic, Biosense-Webster, Abbott, and Boston Scientific; GBC and CdA received compensation for teaching purposes and proctoring from Medtronic, Acutus Medical, Biosense-Webster, Biotronik, Abbott Medical, Boston Scientific, and Philips. All other authors have no financial interests.

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Nekić, A., Prepolec, I., Pašara, V. et al. 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. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01752-8

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