Symptomatic Paroxysmal or Persistent Atrial Fibrillation Can Be Successfully Treated Using the Arctic Front Cryoballoon Alone or in Combination with Linear Radiofrequency Catheter Ablation

Aims: Pulmonary vein isolation (PVI) by cryoballoon (CB) or radiofrequency (RF) catheter ablation (CA) are effective methods to treat symptomatic drug-refractory (SD) paroxysmal (Px) atrial fibrillation (AF). Limited data exists employing CB to treat persistent (Ps) AF.

Methods and Results: 80 patients (pts), 60m/20f, mean age 64, with SDAF underwent CA with PVI using the Arctic Front Cryoballoon Advanced^©. Patients not in sinus rhythm (SR) after PVI had RF lesions placed from the left atrial septum to left inferior PV along the posterior mitral valve/coronary sinus. Any atrial flutter was ablated using RF. All pts were in SR after CA. PVI was proven by paced entrance and exit block. 45 pts had PxAF and 35 pts had PsAF, defined by AF at the start of procedure off antiarrhythmic drugs (AA). All pts were followed for 12 months, 29 pts were followed for 24 months. 33 pts had CBA alone (26 PxAF, 7 PsAF) and 47 pts (19 PxAF, 28 PsAF) required RFCA. After a single ablation procedure, at 12 months, 76 pts (95%) were improved. 44 of 45 (98%) PxAF pts and 32 of 35 (91%) PsAF pts were asymptomatic. 73 pts (93%) were in SR and 3 pts (all PsAF) redeveloped AF, but were asymptomatic. 31 pts (39%) were still on AA drugs; 13 (29%) PxAF vs 18 (51%) PsAF (p=0.04). Of the 29 pts followed to 24 months, 27 pts (93%) were improved. Of those, 12 of 13 (92%) PxAF pts and 15 of 16 (94%) PsAF pts were asymptomatic. 24 pts (83%) were in SR, and 3 pts (all PsAF) had asymptomatic AF. At 24 months, 14 pts (48%) were on AA drugs; 6 (46%) PxAF pts vs 8 (50%) PsAF (p=NS).

Conclusions: Symptomatic drug resistant PxAF and PsAF can be treated with equal success achieving >90% improvement in symptoms or maintenance of SR by a single CBA PVI alone or CBA plus limited RF linear catheter ablation.