Abstract 4647: Long-Term Results after Repeated Cryoballoon Ablation of Paroxysmal or Persistent Atrial Fibrillation without On-Top-Therapie
Background: Circumferential pulmonary vein (PV) ablation represents a challenging technique that may involve fatal complications. Thus, the cryoballoon technique has been developed to improve feasibility and safety. We investigated efficacy and safety of repeated cryoballoon PV ablation without on-top-therapy via a single transseptal puncture only.
Methods: Fourty-six patients (23 female, age 57.7 ± 4.0 years) with highly symptomatic paroxysmal (n=33) or persistent (n=13) atrial fibrillation (AF) underwent cryoballoon ablation using the 28 mm (n=42) or 23 mm (n=4) balloon catheter. In case of AF recurrence after a blanking time of two months, a second procedure was performed earliest three months after the first procedure, using the other balloon size. AF recurrence was evaluated every three months by a 5-day Holter-ECG or a 7-day event recorder.
Results: A hundred eighty-one PV were treated by 398 cryoapplications (2.2 ± 0.4 applications per PV) in the first procedure. After a mean follow-up (FU) of 10.4 ± 5.3 months (range 3.1 – 23.3) after a single procedure, only 28.3% (n=13) of all patients showed sinus rhythm (SR; paroxysmal vs. persistent AF: 27.3 vs. 30.8%; n.s.), whereas 67.4% (n=31) remained free of AF recurrence at the 3-month-FU (31% of them receiving antiarrhythmic (AA) drug therapy). Fifteen patients underwent a second procedure. Three months after reablation, 80% (n=12) of these patients showed SR, whereas after a mean FU of 7.5 ± 5.0 months (range 3.0 – 18.9) after reablation, only 53.3% (n=8) remained free of AF recurrence (none of them on AA drug treatment). After 1.3 procedures per patient, AF symptoms in patients showing AF recurrence, resolved completely in 14%, improved considerably in 68%, and remained unchanged in 18%. In 61 procedures, major complications were cardiac tamponade in one (1.6%) and phrenic nerve palsy in four patients (6.6%; two of them resolved completely, two improved during FU). No death occurred.
Conclusions: Repeated cryoballoon ablation alone without on-top-therapy does not appear to be an efficacious technique in the long-lasting restoration of SR. Nevertheless, in the majority of patients, symptomatic AF can be improved considerably.