Predictors of Early Versus Late Atrial Tachyarrhythmia Recurrence After Cryoballoon Ablation by Atrial Fibrillation Type

Abstract

ABSTRACT Introduction Patient characteristics and predictors of early (ERAT) and late (LRAT) recurrence of atrial tachyarrhythmia by atrial fibrillation (AF) type after cryoballoon ablation (CBA) remain poorly defined. Methods Using the Korean Heart Rhythm Cryoballoon Registry (12 centers, 2018–2022), 2051 patients undergoing CBA for drug‐refractory AF were stratified by AF type. ERAT was defined as atrial tachyarrhythmia within the 3‐month blanking period and LRAT as recurrence beyond 3 months. Independent predictors of ERAT (all patients) and LRAT (patients without ERAT) were identified. Results ERAT occurred in 631 patients (30.8%; 17.6% in paroxysmal and 40.4% in persistent AF). Among 1420 patients without ERAT, LRAT occurred in 311 (21.9%; 16.7% paroxysmal, 27.2% persistent). In paroxysmal AF, coronary artery disease (HR 1.60; 95% CI, 1.00–2.56; p = 0.048) and LA enlargement (HR 1.07; 95% CI, 1.04–1.10; p < 0.001) predicted ERAT, whereas hypertrophic cardiomyopathy (HR 5.01; 95% CI, 2.20–11.42; p < 0.001) and LA enlargement (HR 1.04; 95% CI, 1.01–1.08; p = 0.019) predicted LRAT. In persistent AF, AF duration (HR 1.04; 95% CI, 1.02–1.06; p < 0.001) and LA enlargement (HR 1.03; 95% CI, 1.02–1.04; p < 0.001) predicted ERAT, and LA enlargement (HR 1.03; 95% CI, 1.01–1.05; p = 0.010) independently predicted LRAT. Conclusion Predictors of ERAT and LRAT differed between patients with paroxysmal and those with persistent AF. LA enlargement was the most consistently shared predictor across recurrence phenotypes.