Timing of early recurrence predicts long-term outcomes after cryoballoon pulmonary vein isolation
A Baimbetov, K Bizhanov, A Sarsenbayeva, N Bigeldiyev, A Sapunov, D AbdimalikovaAbstract
Background
Current guidelines recommend that atrial fibrillation (AF) recurrences within the first 90 days after pulmonary vein isolation (PVI) should not prompt immediate re-ablation; this period is therefore accepted as the "blanking period." However, accumulating data suggest that early atrial arrhythmia recurrences during this period may predict long-term outcomes. The optimal timing for considering re-ablation following early recurrence remains uncertain.
Objective
to evaluate whether the timing of early atrial arrhythmia recurrence during the 90-day blanking period after first-time CryoPVI predicts long-term procedural efficacy, and to determine when re-ablation should be considered.
Methods
We prospectively analyzed consecutive AF patients who underwent first-time cryoballoon PVI (CryoPVI) at a single center between 2019 and 2024. Patients were classified into four groups based on the timing of atrial arrhythmia recurrence during the blanking period: 0–30 days, 30–60 days, 60–90 days, and no recurrence within 90 days. CryoPVI was performed using a standardized protocol. Follow-up was conducted at 3, 6, 12, 18, 24, and 36 months. The primary efficacy endpoint was symptomatic atrial arrhythmia recurrence.
Results
A total of 1,222 patients underwent first-time CryoPVI. Early atrial arrhythmia recurrence occurred in 89 patients (7.3%) within 0–30 days, 44 patients (3.6%) within 30–60 days, and 41 patients (3.3%) within 60–90 days. Overall, 1,048 patients (85.8%) had no arrhythmia recurrence during the 90-day blanking period. At 36 months, the incidence of the primary efficacy endpoint was significantly higher among patients with early recurrence (0–30 days: 63.3%; 30–60 days: 71.6%; 60–90 days: 78.3%) compared with those without recurrence ≤90 days (42.3%; p < 0.0001).
Conclusion
Atrial arrhythmia recurrence during the first 90 days after CryoPVI is associated with significantly reduced long-term procedural efficacy. These findings suggest that re-ablation may be considered regardless of the timing of early recurrence within the blanking period.