Long-term outcomes of cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation

Hikmet Yorgun*, Ugur Canpolat, Metin Oksul, Yusuf Ziya Sener, Ahmet Hakan Ates, Harry J. G. M. Crijns, Kudret Aytemir

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF.

Methods and results We compared 144 persistent AF patients (5910years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 +/- 6years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG's, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (>= 30s) after a 3-month blanking period. At a mean of 30.5 +/- 5.6months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P=0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P=0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81-5.03; P

Conclusions Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.

Original languageEnglish
Pages (from-to)1653-1662
Number of pages10
JournalEP Europace
Issue number11
Publication statusPublished - Nov 2019


  • Atrial fibrillation
  • Pulmonary vein isolation
  • Cryoballoon
  • Left atrial appendage isolation
  • FLOW

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