title: Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success.
abstract: OBJECTIVE
  Long-term efficacy following cryoballoon (CB) ablation of atrial fibrillation (AF) remains unknown. This study describes 5 years follow-up results and predictors of success of CB ablation in patients with paroxysmal atrial fibrillation (PAF).
  
  
  RESULTS
  In total, 163 patients were enrolled with symptomatic, drug refractory PAF. Pulmonary vein isolation (PVI) with CB technique was performed. Primary endpoint of this consecutive single-centre study was first electrocardiogram-documented recurrence of AF, atrial tachycardia or atrial flutter (AFLAT). Five years success rate after single CB ablation was 53%. In 70% of the patients acute complete PVI was achieved with a single 28 mm balloon. The univariate predictors of AFLAT recurrence were (1) size of left atrium, with normalized left atrium (NLA) ≥10.25 [hazard ratios (HR) of 1.81, 95% confidence interval (CI): 1.28-2.56] when compared with NLA <10.25 (35% vs. 53%, P = 0.0001) and (2) renal function, with impaired glomerular filtration rate (GFR) <80 ml/min (HR of 1.26, 95% CI: 1.02-1.57) when compared with GFR ≥80 ml/min (45% vs. 53%, P = 0.041). Normalized left atrium ≥10.25 was the sole independent predictor for outcome (HR 2.11; 95% CI: 1.34-3.31; P = 0.0001).
  
  
  CONCLUSIONS
  Sinus rhythm can be maintained in a substantial proportion of patients with PAF even 5 years after circumferential PVI using CB ablation. The rate of decline in freedom from AFLAT was highest within the first 12 months after the index procedure. The patients with enlarged left atrium and/or impaired renal function have lower outcome.
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany. t.neumann@kerckhoff-klinik.de
authors: Thomas
authors: T
authors: Neumann
authors: Maciej
authors: M
authors: Wójcik
authors: Alexander
authors: A
authors: Berkowitsch
authors: Damir
authors: D
authors: Erkapic
authors: Sergey
authors: S
authors: Zaltsberg
authors: Harald
authors: H
authors: Greiss
authors: Dimitri
authors: D
authors: Pajitnev
authors: Stefan
authors: S
authors: Lehinant
authors: Jörn
authors: J
authors: Schmitt
authors: Christian W
authors: CW
authors: Hamm
authors: Heinz F
authors: HF
authors: Pitschner
authors: Malte
authors: M
authors: Kuniss
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D003452:Cryosurgery / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Ablation; Arrhythmia; Catheter ablation; Cryoballoon; Long-term follow-up; Paroxysmal atrial fibrillation; Pulmonary vein isolation; Tachyarrhythmias