1St. Josefs Hospital Medizinische Klinik I Wiesbaden, Deutschland
Background
Atrial fibrillation (AF) is a cardiologic epidemic with increasing prevalence and incidence as well as associated increased mortality. It is important to rule out possible periprocedural factors influencing the success of cryoballon pulmonary vein isolation (CryoPVI). For example, anatomically difficult conditions and different experiences of the examiners could potentially influence the success of the therapy. A possible influence on the effectiveness of CryoPVI could be the number of cryo-balloon application attempts until complete isolation of the pulmonary vein is achieved. No prospective data is yet available on this.
Methods
We prospectively analyzed consecutive AF patients who underwent CryoPVI in a single-center cohort between 2018 and 2023. Depending on the number of ablation attempts until complete isolation of the pulmonary vein was achieved, we divided the patients into two groups. CryoPVI was performed in a standardized fashion. Follow-up was performed at 3, 6, and 12 months after CryoPVI. Endpoints were symptomatic atrial arrhythmia relapse for efficacy and major inguinal complications, phrenic nerve injury, stroke or death for safety. Periprocedural parameters were observed.
Results
During the study period 1170 patients underwent CryoPVI. Of these, in 610 patients only one ablation attempt per pulmonary vein was required to achieve complete isolation. While there was no significant difference in gender (49.9 % male vs. 50% male p=0.09) and entity of atrial fibrillation (49.9% persistent AF vs. 50.1% persistent AF, p=0.23) between the two groups, patients who required only one ablation attempt had a significantly higher CHADS-VASc (2.86 vs. 2.62, p=0.006) and were older (70.1 vs. 68.5, p=0.006). After 12 months there was no difference in incidence of primary efficacy endpoint between both groups. Primary safety endpoints occurred in form of three major access complications (0.5% vs. 0.5%) and one stroke within 30 days post-procedure (0.2% vs. 0.2%) in each group.
Conclusion
The number of cryoballoon-applications until complete isolation of the pulmonary vein is achieved has no influence on effectiveness and safety of CryoPVI.