Incidence and Significance of Early Recurrences of Atrial Fibrillation After Cryoballoon Ablation: Insights From The Multicenter STOP AF Trial

Study Questions:

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.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Research Personnel, Pulmonary Veins, Cryosurgery, Electrocardiography, Catheter Ablation

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