Long-term outcomes of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation in Chinese patients

Purpose We aimed to study the long-term outcomes of cryoballoon (CB) pulmonary vein isolation (PVI) in treating Chinese patients with atrial fibrillation (AF). Methods A total of 122 patients (48 women, mean age 57.4 +/- 11.3) underwent CB PVI (first generation CB 44.3%, second generation CB 55.7%) for AF (paroxysmal 65.6%, persistent 10.7% and long-standing persistent 23.8%). Results PVI was achieved in 113 (92.6%) patients with CB alone, and it was achieved in all patients with additional touch-up by 8-mm-tip cryocatheter. The mean procedural and fluoroscopic duration were 171.9 +/- 41 and 46.6 +/- 14.6 min respectively. The recurrence-free survival for paroxysmal and non-paroxysmal AF was 77% and 59% respectively at 1 year and progressively declined over time to reach a plateau of 52% and 30% for paroxysmal and non-paroxysmal AF respectively at 5 years. In patients undergoing PVI with second-generation CB, the recurrence-free survival was 75% for paroxysmal AF and 45% for non-paroxysmal AF at 5 years. With multivariate Cox regression analysis, the types of CB (use of second-generation CB: HR 0.49; 95% CI 0.28-0.85; p = 0.011) and size of left atrium (LA) (larger LA size: HR 1.52; 95% CI 1-2.14; p = 0.017) independently predicted recurrence. Transient phrenic nerve injury (PNI) occurred in four (3.3%) patients and persistent PNI occurred in four (3.3%) patients. Other complications occurred in 10 (8.2%) patients with no procedure-related death. Conclusions Long-term success of CB PVI for AF declined over time and reached a plateau at 5 years. CB types and LA size are independent predictors for long-term recurrence.