Effect of early cryoballoon ablation on atrial fibrillation recurrence—A Danish nationwide register study

• Published in: Journal of cardiovascular electrophysiology Vol. 35; no. 7; pp. 1429 - 1439
• Main Authors: Hein, Regitze, Riis‐Vestergaard, Lise Da, Tønnesen, Jacob, Zörner, Christopher Ryan, Rasmussen, Peter Vibe, Ruwald, Martin Huth, Johannessen, Arne, Worck, René Husted, Hansen, Jim, Middelfart, Charlotte, Gislason, Gunnar Hilmar, Hansen, Morten Lock
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2024
• Subjects: Ablation; Action Potentials; Aged; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiac arrhythmia; catheter ablation; Cryosurgery - adverse effects; cryo‐ablation; Denmark - epidemiology; Diagnosis; diagnosis‐to‐ablation time; Female; Fibrillation; Heart Rate; Humans; Male; Middle Aged; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Recurrence; Registries; Regression analysis; Risk Assessment; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome; Denmark; cryo‐ablation; atrial fibrillation; catheter ablation; diagnosis‐to‐ablation time
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16303

Introduction
Cryoballoon ablation is a safe and efficient rhythm control strategy in atrial fibrillation (AF) patients. The impact of time from diagnosis to ablation is unclear. The aim of this study was to examine the impact of timing of first‐time cryoballoon ablation on AF recurrence in a nationwide cohort of AF patients.
Methods and Results
From nationwide registers, all AF patients ≥18 years of age who underwent first‐time AF cryoballoon ablation in Denmark from 2012 to 2018 were included. The AF patients were stratified by ablation timing: Early group (≤1 year after AF diagnosis), intermediate group (1–3 years after AF diagnosis), and late group (≥3 years after AF diagnosis). By adjusted Cox regression models, the effect of timing on AF recurrence was examined.
This study included 1064 AF patients with a median age of 63 years. Most patients were male (66%) and had paroxysmal AF (67%). The 1‐year risk of AF recurrence increased from 31% in the early group to 41% and 44% in the intermediate and late group. The hazard ratios (95% confidence intervals) were 1.28 (0.95, 1.74) in the intermediate group and 1.42 (1.09, 1.86) in the late group when compared to the early group. Continuous diagnosis‐to‐ablation time seemed to have the greatest impact on AF recurrence within the first 2 years.
Conclusion
In AF patients undergoing cryoballoon ablation, late timing of ablation was associated with a significantly higher AF recurrence rate when compared to early timing of ablation. These findings support early cryoballoon ablation to improve the outcomes after ablation.
In this register‐based study of 1064 atrial fibrillation patients, late cryoballoon ablation (≥3 years after first AF‐diagnosis) was associated with a significantly higher atrial fibrillation recurrence rate compared to early cryoballoon ablation (≤1 year after first AF‐diagnosis). Notably, diagnosis‐to‐ablation time exerted the greatest impact on atrial fibrillation recurrence within the initial 2 years after first atrial fibrillation diagnosis, emphasizing the importance of timing of first‐time cryoballoon ablation. AF, atrial fibrillation; CI, confidence interval; HR, hazard ratio.