Ten-year follow-up after endocardial point-by-point cryoablation for paroxysmal atrial fibrillation

Background: Since many years catheter ablation is widely used for the treatment of atrial fibrillation (AF), however, long-term follow-up data of ablation techniques are rare. This study presents a 10-year follow-up period in patients treated for paroxysmal AF (PAF) with point-by-point pulmonary vein isolation (PVI) using cryothermal energy (cryoPVI). The main objective is to investigate whether cryoPVI is able to create durable PVI. Methods: All consecutive patients with PAF who underwent a point-by-point cryoPVI were included. Information from the index procedure, anti-arrhythmic drug (AAD) use, recurrence of arrhythmias and re-ablation, was retrospectively analysed. Re-ablations were specifically evaluated for reconnection of PVs. Results: Seventy-three patients were included. Five (7%) were lost to follow-up and 55/73 (75%) reached 10-year follow-up (median follow-up duration: 11.3 years [10.0-12.4]). Thirteen (18%) did not reach 10-years follow-up (mean follow-up duration: 4.4 +/- 3.3 years). All targeted PVs were successfully isolated during the index procedure. Only 10/68 patients (15%) kept sinus rhythm (SR) without the use of AAD or a re-ablation. Re-ablations were performed in 47/68 patients (69%). Reconnection was seen in 81% of the PVs. Conclusions: Ostial point-by-point cryoPVI has the ability to provide acute electrical isolation of arrhythmogenic PVs based on abolition of all PV potentials, but fails in long-term isolation and prevention of AF-recurrence in most patients.