A frozen decade: Ten years outcome of atrial fibrillation ablation using a single shot device for pulmonary vein isolation

Aims Cryoballoon-guided pulmonary vein isolation (CB-PVI) for symptomatic atrial fibrillation (AF) has become an established treatment option with encouraging results in terms of safety and efficacy. Data reporting on long-term data beyond a follow-up (FU) period of 5 years is scarce. This prospective study aimed to evaluate very long-term outcome after CB-PVI for AF. Methods Data from consecutive patients treated with CB-PVI for symptomatic and drug refractory AF between 2005 and 2012 were analyzed. Patients with a FU of >= 9 years after index CB-PVI were included. All patients were continuously followed-up in our outpatient clinic. Arrhythmia recurrence was defined as AF or atrial tachycardia (AT) lasting >30 s beyond a 3-month blanking period. Results A total of 385 patients (71% male) were included. Mean age was 58 +/- 10 years and paroxysmal AF was present in 93% of patients. Mean FU duration was 124 +/- 24 months. At the end of the observational period, 73% of all patients were in stable sinus rhythm after a mean of 2 +/- 0.8 ablation procedures. Patients with AF/AT recurrence were older (60 +/- 8 vs. 57 +/- 10 years; p = .019), had a higher CHA(2)DS(2)-Vasc Score (2.47 +/- 1.46 vs. 1.98 +/- 1.50; p = .01) and presented with a larger left atrium (LA)-diameter (43 +/- 5.6 vs. 40 +/- 5.1 mm; p = .002). The LA-diameter was also a significant predictor for AF/AT recurrence after CB-PVI (odds ratio: 0.939, 95% confidence interval: [0.886, 0.992], p = .03). Conclusions CB-PVI as index procedure for AF ablation resulted in favorable long-term outcome in symptomatic AF. CB-PVI might be recommended as interventional therapy in patients with lower LA remodeling.