Incidence and Significance of Early Recurrences of Atrial Fibrillation After Cryoballoon Ablation: Insights From The Multicenter STOP AF Trial
What is the incidence and prognostic significance of early arrhythmia recurrence following cryoballoon ablation of the pulmonary veins (PVs) for paroxysmal atrial fibrillation (AF)?
In a prespecified analysis of the STOP AF trial (cryoablation vs. medical therapy), the investigators sought to determine the incidence of early recurrence of AF (ERAF) (within 3 months) among 163 patients who were randomized to ablation. Rhythm status was based on regular electrocardiograms, weekly transtelephonic monitoring, and symptoms. A subset of patients with early recurrence (n = 30) underwent re-ablation in a nonrandomized fashion within the first 3 months.
ERAF was diagnosed in 84 of the 163 study patients (52%), and occurred within the first month following the procedure in the majority. Fifty-six percent of patients with ERAF experienced late recurrence, as opposed to only 13% who did not have ERAF (p < 0.0001). Freedom from AF was greater among patients with ERAF who underwent early re-ablation (97%) versus those who did not (44%). Roughly one-half of the patients with ERAF did not experience late recurrence.
The authors concluded that ERAF occurs in approximately 50% of patients with paroxysmal AF undergoing cryoballon ablation of the PVs, and is associated with late recurrence. Re-ablation of ERAF within the first 3 months seems to prevent late recurrence.
As for patients undergoing radiofrequency ablation for paroxysmal AF, patients undergoing cryoablation commonly experience ERAF. Although many patients with ERAF require a repeat procedure, the common practice of delaying re-ablation is supported by the results of this study since approximately one-half of the patients with early recurrence did not experience late recurrence. A prior study noted that although ERAF patients with early re-intervention seem to do well, such a strategy is also associated with a higher total number of procedures per patient. Thus, barring a strong clinical indication for an early redo procedure, most patients with ERAF with any technology are probably well served with medical therapy within the first 3 months, and then re-ablation for recurrent arrhythmias thereafter.
Keywords: Research Personnel, Pulmonary Veins, Cryosurgery, Electrocardiography, Catheter Ablation
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