Long-term incidence and predictive factors of thromboembolic events after a cryoballoon ablation for atrial fibrillation

Background: Long-term outcomes in terms of thromboembolic events (TEs) are poorly described after cryoballoon pulmonary vein isolation (cryo-PVI) for atrial fibrillation (AF). We evaluated the long-termincidence and predictive factors of TE after cryo-PVI.Methods: All consecutive patients who underwent cryo-PVI for paroxysmal or persistent AF between November 2012 and October 2017 were included. They were prospectively followed for at least 12 months in the ablation center and then by their cardiologist. Data on all ischemic events (stroke, transient ischemic attack (TIA), systemic embolism) were collected.Results: In total, 450 patients (78% men, median age 61 years) were included. The mean CHA(2)DS(2)-VASc score was 1.6 +/- 1.3 and 26 patients (6%) had a history of stroke/TIA before the procedure. OATwas discontinued for 75 patients (17%) after the procedure, among whom 50 (67%) had no indication for long-termanticoagulation. Six patients experienced an ischemic event, all considered as a TE: three strokes, two TIAs, and one acute lower-limb ischemia. The mean followup was 30 months. Thus, the incidence of TEwas 0.53%/year. Three of the six patients who experienced a TE had no recurrence of atrial arrhythmia documented before, at the time, or after the event. All patients who experienced a TE had a class I or class IIa indication for long-term anticoagulation. After multivariate analysis, the CHA(2)DS(2)-VASc Score (p =.0005) was a predictor of TEs.Conclusion: The long-termincidence of TEs after cryo-PVI was 0.53%/year. The CHA(2)DS(2)-VASc Score was the only independent predictor of TEs. (C) 2020 Elsevier B.V. All rights reserved.