64Cryoablation for persistent and long standing persistent atrial fibrillation: a single centre experience

Abstract

Background: Pulmonary vein isolation using the cryoballoon is an effective treatment option for patients with atrial fbrillation (AF). Although it is well established in the treatment of paroxysmal AF, the role of cryoablation in persistent AF remains unknown. Objective: We examined the procedural success and long-term outcomes of cryoablation in persistent AF and long standing persistent AF. Methods: A prospective single centre registry of consecutive patients undergoing cryoablation for persistent AF was analysed. All procedural data, complications and follow up were prospectively recorded. Patients were followed up at 3, 6 and 12 months with an ECG with open access to arrhythmia nurse specialists thereafter. Ambulatory monitoring was dictated by symptoms. Results: Over a 28 month period 251 patients underwent ablation with the cryoballoon for persistent AF. 66% were male with a mean age of 63 ± 13 years. 204 (81%) had persistent AF (<1yr duration) and 47 (19%) had long standing persistent AF (> 1 year). Acute procedural success (defned as pulmonary vein isolation using the cryoballoon alone) was 98%. Major complications were seen in 4 (1.6%) patients (2 tamponades, 1 phrenic nerve palsy and 1 haematoma). Mean procedure time was 74 ± 34 minutes and fuoroscopy time was 10 ± 9 min. Over a follow-up of 1.7 ± 0.5 years, the single procedure success rates were 114/177 (64%) for persistent AF and 17/27 (62%) for longstanding persistent AF The rate of repeat procedures was 31/177 (18%) for persistent AF and 9/27 (33%) for longstanding persistent AF. Conclusion: Cryoablation for persistent AF is safe, fast and has good outcomes at one-year follow-up. Cryoablation is reasonable as a frst line option for patients with persistent AF and long-standing persistent AF The short procedure time may help increase capacity of cardiac units to help meet the rising demand for AF ablation. Randomized controlled trials are needed to compare outcomes with different techniques.