Background

Cryoballoon Pulmonary-Vein Isolation (cryoPVI) is well established for treatment of paroxysmal atrial fibrillation (AF) but its efficacy in persistent AF is unclear due to still limited amount of prospective data addressing this topic. 

Objective

To prospectively compare cryoPVI in patients with paroxysmal and persistent AF with respect to efficacy, safety and periprocedural parameters.

Methods

We analyzed consecutive patients who underwent cryoPVI in a single-center cohort between 2018 and 2020. Follow-up was performed at 3, 6, 12, 18 and 24 months after ablation. Endpoints were: symptomatic AF relapse after a 90-day blanking period for efficacy and bleeding, phrenic nerve injury, stroke or death for safety. Statistical analysis was performed by log rank test.

Results

We included 464 patients into the analysis, of these 286 had paroxysmal AF (age 69±10 years, CHA2DS2-VASc 2.7±1.5, 51% male) while 178 had persistent AF (age 69±11 years, CHA2DS2-VASc 2.8±1.6, 59% male). Freedom from AF after 24 months was similar for paroxysmal and persistent AF (63 % vs. 53.1%, P=0.31, Figure). Primary safety end point occurred in two patients with paroxysmal AF (0.7%) and three with persistent AF (1.7%) in form of pericardial effusion or transient phrenic nerve injury. No deaths or strokes were observed in either group, fluoroscopy time (7.6±3.7min vs. 7±3.6min P=0.93), left-atrial dwell time (40.5±15.5min vs. 41.7±21.1min, P=0.25) and procedure time (56.4±15.8min vs. 54.8±17.7min, P=0.29) were similar.

Conclusion

CryoPVI is as effective and safe for treatment of persistent AF as it is for paroxysmal AF.