Intermediate-term outcome of cryoballoon ablation of persistent atrial fibrillation and improvements in quality of life of patients

Daniel Mol, Anchee M Boersma, Wouter R Berger, Muchtiar Khan, Gijsbert S de Ruiter, Geert-Jan P Kimman, Joris R de Groot, Jonas S S G de Jong, Daniel Mol, Anchee M Boersma, Wouter R Berger, Muchtiar Khan, Gijsbert S de Ruiter, Geert-Jan P Kimman, Joris R de Groot, Jonas S S G de Jong

Abstract

Background: Clinical outcome of pulmonary vein isolation (PVI) has been predominantly focused on the reoccurrence of atrial fibrillation (AF) and the maintenance of sinus rhythm. However, there has been a limited intermediate follow-up on health-related quality-of-life (HRQoL) of patients. Given the relatively high recurrence rate of persistent AF after PVI treatment, it is important to follow up with clinical outcomes on symptom improvement as well as health-related quality-of-life. This study was designed to investigate the recurrence rate of atrial tachyarrhythmia (ATa), AF-related symptoms and HRQoL after PVI in patients with persistent AF who were treated with the second generation cryoballoon.

Methods: Total 148 patients participated in the study who were treated by PVI between 2013 and 2017 for persistent AF. All patients visited the out-patient clinic 2-5 years after PVI. During this visit all patients filled-out an AF Effect on Quality-of-life (AFEQT) questionnaire and a seven-day Holter was applied. All rhythm recordings acquired post ablation were collected and analysed, and the modified European Heart Rhythm Association score (mEHRA) scores were calculated before and after the ablation.

Results: The average age of patients was 63±9 year old and 44 (27.9%) were female. Mean CHA2DS2 VASc score was 1.9±1.4, and moderate and severe left atrial (LA) dilation was present in 53 (36.1%) and 15 (10.2%) patients, respectively. After a follow-up of 3.7±1.0 years, 81 (54.7%) patients had an ATa recurrence and 35 (23.6%) patients underwent a repeat LA ablation. However, the mEHRA score significantly improved in 80.4% of the patients (p <0.001), with the median overall AFEQT score of 88.9 [70.4-97.2].

Conclusions: There is a considerable ATa recurrence rate after PVI of persistent AF at intermediate-term follow-up. However, our data indicate that PVI significantly improved AF-related symptoms and resulted in a high HRQoL for 2-5 years in patients with persistent AF.

Conflict of interest statement

D. Mol reports speaker/consultancy fee from Abbott. Dr. J.R. de Groot reports research grants through his institution from Abbott, Atricure, Boston Scientific, Bayer, Daichi Sankyo, Johnson&Johnson, and Medtronic. In addition, he reports speaker/consultancy fees from Atricure, Bayer, Daiichi Sankyo, Johnson&Johnson, Medtronic, Novartis, Servier. Dr. de Jong reports consultancy fees from Medtronic, and speaker fees from Daiichi-Sankyo and Bayer. All the grants and fees received by the authors are outside the submitted work.

Figures

Fig 1. Flowchart of patient selection process.
Fig 1. Flowchart of patient selection process.
Fig 2. Arrhythmia free survival analyses.
Fig 2. Arrhythmia free survival analyses.
A. Survival analysis of freedom of any atrial arrhythmia. B. Survival analysis of freedom of atrial fibrillation.
Fig 3. Arrhythmia free survival analyses.
Fig 3. Arrhythmia free survival analyses.
A. Survival analysis of freedom of atrial tachycardia. B. Survival analysis of freedom of any atrial arrhythmia after multiple ablations.
Fig 4. Type of atrial fibrillation per…
Fig 4. Type of atrial fibrillation per year of follow-up.
A. The type of atrial fibrillation (AF) reported for each follow-up year per patient. B. Overall AFEQT score per year. Of note, figure does not display repeated measurements.
Fig 5. Health-related quality-of-life and AF related…
Fig 5. Health-related quality-of-life and AF related symptoms.
A. mEHRA score before pulmonary vein isolation (PVI) and at follow-up. The arrow thickness corresponds to the proportion of patients. B. Correlation between mEHRA score and Atrial Fibrillation Effect on Quality-of-life (AFEQT) score at follow-up.

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