First-pass isolation as an independent predictor of atrial fibrillation recurrence after cryoballoon ablation in patients with persistent atrial fibrillation
S J Park, H J Lee, H Y Park, E S Jang, J H Ha, J W Kim, J Y Kim, S J Park, K M Park, Y K OnAbstract
Background
Data on predictors of atrial fibrillation (AF) recurrence after cryoballoon pulmonary vein isolation (PVI) in patients with persistent AF (PeAF) remain limited. We evaluated clinical, echocardiographic, and procedural parameters associated with arrhythmia recurrence.
Methods
We retrospectively studied 192 consecutive PeAF patients who underwent cryoballoon PVI and had ≥6 months of follow-up. Recurrence was any atrial tachyarrhythmia >30 s beyond a 3-month blanking period. Cox models assessed predictors, including number of veins with first-pass isolation (FPI), left atrial volume index (LAVI), hemoglobin, and prespecified covariates. Kaplan–Meier analyses illustrated recurrence-free survival.
Results
Over 698 ± 303 days of follow-up, recurrence occurred in 75/192 (39.1%) patients. On multivariable analysis, reduced extent of FPI (<3 veins) independently predicted re-currence (HR 2.48, 95% CI 1.48–4.16; p=0.001). In continuous analysis, each one-vein decrement in FPI related to a 58% higher hazard in univariate testing. Lower hemoglobin was also independently associated (per 1 g/dL decrease: HR 1.29, 95% CI 1.05–1.58; p=0.015), and male sex showed an independent association (HR 2.23, 95% CI 1.06–4.68; p=0.034). In PeAF patients treated with cryoballoon PVI, the intraprocedural FPI extent was the dominant predictor, outperforming anatomical remodeling after ad-justment. Achieving FPI in fewer than three pulmonary veins predicted higher recur-rence. Hemoglobin provides an accessible systemic risk marker, while male sex identi-fied a higher-risk subgroup.
Conclusion
In PeAF patients, the extent of FPI in cryoballoon PVI is a dominant predictor of out-come and maximizing the number of veins with FPI could be a pragmatic procedural goal.