1St. Josefs Hospital Medizinische Klinik I Wiesbaden, Deutschland
Background
Current guidelines do not consider the occurrence of an AF recurrence within the first 90 days after CryoPVI to have any influence on effectiveness. A blanking period of 90 days is typically accepted after PVI. However, there is data to suggest that early relapses during the blanking period matter. The optimal time for re-ablation therefore remains unclear.
Methods
We prospectively analyzed consecutive AF patients who underwent CryoPVI in a single-center cohort between 2018 and 2023. Depending on a recurrence of atrial arrhythmia within the first 90 days, we divided the patients into four groups (recurrence ≤ 30 days, recurrence > 30 ≤ 60 days, recurrence >60 ≤ 90 days and no recurrence within the first 90 days).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.
Results
During the study period 1180 patients underwent CryoPVI. Of these, 84 patients (7.1%) had a recurrence of an atrial arrhythmia between 0-30 days, 38 patients (3.2%) had a recurrence of atrial arrhythmia between 30-60 days, 38 patients (3.2%) had a recurrence of atrial arrhythmia after between 60-90 days and 1020 (86.4%) patients didn’t have a recurrence of atrial arrhythmia between 0-90 days after CryoPVI. After 12 months incidence of primary efficacy endpoint was significant higher in patients who suffered a recurrence of atrial arrhythmia within the first 90 days (between 0-30 days 52.1% vs. between 30-60 days 53.2% vs. between 60-90 days 58.6% vs. no recurrence ≤ 90 days 20.3%, p<0.0001).
Conclusion
Recurrence of an atrial arrhythmia within the first 90 days is associated with a reduced effectiveness of CryoPVI. Further ablation should be evaluated regardless of the time of recurrence.