Cryoballoon Ablation for Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: One-Year Outcome Using Second Generation Cryoballoon.
BACKGROUND
Data regarding the freedom from atrial fibrillation (AF) in the follow-up of persistent AF patients is limited. The second-generation cryoballoon has better cooling properties compared with first-generation cryoballon. In this study, we aimed to assess the medium-term efficacy of second-generation cryoballoon in patients with persistent AF.


RESULTS
A total of 100 patients (63±10 years, 80% male) with symptomatic persistent AF, despite ≥1 antiarrhythmic drug(s), who were scheduled for pulmonary vein isolation using second-generation cryoballoon were enrolled in this study. Follow-up was based on outpatient clinic visits, including Holter ECGs. Recurrence was defined as a symptomatic or documented arrhythmia episode of >30 seconds excluding a 3-month blanking period. As a result, 393 pulmonary veins (7 patients with common ostium) were successfully isolated. Mean procedural and fluoroscopy times were 96.2±21.3 and 19.7±6.7 minutes, respectively. Phrenic nerve palsy occurred in 3% (3/100) of the patients. At a mean follow-up duration of 10.6±6.3 months, 67% of the patients were in sinus rhythm. Stepwise multivariable Cox proportional hazard regression analysis showed that early AF recurrence (hazard ratio 3.83, 95% confidence interval 1.91-7.68, P<0.001) was the only independent predictor for late AF recurrence apart from other clinical and echocardiographic variables.


CONCLUSIONS
Our findings indicated that second-generation cryoballoon use is associated with favorable outcomes in patients with persistent AF. Recurrence at blanking period was the only predictor of long-term AF recurrence.
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.). b.koektuerk@khporz.de b.koektuerk@web.de.
Buelent
B
Koektuerk
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Hikmet
H
Yorgun
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Oezlem
O
Hengeoez
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Cem H
CH
Turan
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Alina
A
Dahmen
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Alexander
A
Yang
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Paul M
PM
Bansmann
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Eduard
E
Gorr
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Christian
C
Hoppe
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Ramazan G
RG
Turan
From the Department of Cardiology & Electrophysiology (B.K., H.Y., C.H.T., A.D., A.Y., E.G., C.H., R.G.T., M.H.), and Department of Radiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany (P.M.B.); and Klinikum Lüdenscheid Clinic of Internal Medicine, Lüdenscheid, Germany (O.H.).
Marc
M
Horlitz
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D003452:Cryosurgery / Q000295:instrumentation*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
cryoballoon ablation; persistent atrial fibrillation; pulmonary vein isolation