Background: It is unknown whether cryoballoon technology for persistent
atrial fibrillation (AF) is a reasonable initial strategy for patients
with persistent AF (perAF). Methods: 390 consecutive procedures using
cryoballoon for initial AF ablation were evaluated and divided first by
clinical presentation: paroxysmal AF (PAF) or perAF, and then whether PV
potentials associated PV pacing (PV capture) were identified after
ablation. Patients were followed for recurrent AF (median 20 months).
Results: PV capture was identified in patients with PAF and perAF (PAF:
20.3% vs. perAF: 14.6%; p < 0.05). No patient
charactieristic differences were identified between those patients with
or without PV capture. The presence of PV capture was not associated
with different outcomes in patients with PAF. However, in patients with
perAF, the presence of PV capture was associated with long-term outcomes
similar to patients with PAF and significantly better than patients with
perAF without PV capture (p < 0.001). In patients with perAF
and PV capture, a strategy of reisolation of the PVs only for recurrent
AF resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic
medications at study completion. In patients with PV capture, specific
electrophysiologic properties of PV tissue did not have an impact on AF
recurrence. Conclusion: PV capture (and not specific PV
electrophysiologic characteristics) was associated with decreased
recurrent AF in patients with perAF. PV capture may identify those
patients with perAF in whom PV isolation alone is sufficient at initial
ablation procedure and also as the primary ablation strategy for
recurrent AF.
Pulmonary Vein Capture is a Predictor for Long-Term Success of Stand-Alone Pulmonary Vein Isolation with Cryoballoon Ablation in Patients with Persistent Atrial Fibrillation