Instant termination as a novel indicator for prognosis of persistent atrial fibrillation during cryoballoon ablation: a propensity score-matched analysis

Background Instant atrial fibrillation termination (AFT) during radiofrequency ablation has been suggested as a predictor of prognosis in persistent atrial fibrillation (AF). However, its role in cryoballoon ablation remains unclear. This study investigated the association between AFT and recurrent atrial tachyarrhythmia in patients with persistent AF undergoing cryoballoon ablation.Methods Patients with non-valvular, drug-resistant, persistent AF who underwent cryoballoon ablation between January 2021 and June 2023 were included and categorized based on the presence or absence of AFT. Propensity score matching (PSM) was applied to eliminate covariate imbalances. Baseline characteristics, procedural details, and clinical outcomes were compared between the groups.Results A total of 189 patients [65.0 (59.0-71.0) years] were included. Among them, 41 experienced instant AFT, while 148 remained in AF rhythm. The baseline conditions were similar, except that patients with AFT presented significantly lower left atrial diameter (LAD). During a follow-up of 16.0 [9.1-26.9] months, the recurrence rates of arrhythmias were significantly lower in the AFT group (log-rank P = 0.044). Both AFT [HR: 0.298, 95% CI: (0.091-0.976), P = 0.035] and baseline LAD [HR: 1.079, 95% CI: (1.012-1.151), P = 0.021] were independent predictors of recurrence. We further assessed the prognostic value of AFT in PSM groups which showed that the recurrence rates were also significantly lower in the AFT group (log-rank P = 0.049).Conclusion Instant AFT during cryoballoon ablation is associated with a reduced risk of arrhythmic recurrence in patients with persistent AF.