Background

Cryoballoon pulmonary-vein isolation (cryoPVI) is well established for treatment of atrial fibrillation (AF) but the influence of early recurrence of AF during a blanking period of 90 days (ERAF) after ablation remains unclear.

Objective

To prospectively compare outcome of cryoPVI in patients with recurrence of AF during blanking period and patients who remained free from ERAF.

Methods

We analyzed consecutive patients who underwent ablation in a single-center cohort during 2018 and 2020. Ablations were performed in a standardized fashion. 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 458 patients into the analysis. Of these 64 patients presented with AF relapse during blanking period (age 70±8 years, CHA2DS2-VASc 2.9±1.5, 5s3% male) while 394 patients demonstrated freedom from AF within the first 90 days after ablation (age 69±10 years, CHA2DS2-VASc 2.7±1.5, 56% male). Patients with AF recurrence during blanking period showed a significant higher relapse rate than patients without ERAF (65.4 % vs. 22.1%, P<0.0001, Figure). Primary safety endpoint occurred in one patient with ERAF (1.5%) and five patients without ERAF (1.2%). No deaths or strokes were observed.

Conclusion

The recurrence of AF during blanking period after ablation predicts long-term outcome of patients undergoing cryoPVI. Prospective trials should address this specific patient cohort.