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

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.