Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: Insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial

Jason G. Andrade, Paul Khairy, Laurent Macle, Douglas L Packer, John W. Lehmann, Richard G. Holcomb, Jeremy N. Ruskin, Marc Dubuc

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background-Early recurrence of atrial fibrillation (ERAF) is common after radiofrequency catheter ablation for AF. We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation. Moreover, the benefit of early reablation for ERAF after cryoballoon ablation is undetermined. Methods and Results-The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) trial randomized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation. Patients were followed for 12 months. ERAF was defined as any recurrence of AF >30 seconds during the first 3 months of follow-up. Late recurrence (LR) was defined as any recurrence of AF >30 seconds between 3 and 12 months. Of the 163 patients randomized to cryoablation, 84 patients experienced ERAF (51.5%). The only significant factor associated with ERAF was male sex (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.03-4.61; P=0.041). LR was observed in 41 patients (25.1%), and was significantly related to ERAF (55.6% LR with ERAF versus 12.7% without ERAF; P<0.001). Among patients with ERAF, only current tobacco use (HR, 3.84; 95% CI, 1.82-8.11; P<0.001) was associated with LR. Conversely, early reablation was associated with greater freedom from LR (3.3% LR with early reablation versus 55.6% without; HR, 0.04; 95% CI, 0.01-0.32; P=0.002). Conclusions-ERAF after cryoballoon ablation occurs in ≈50% of patients and is strongly associated with LR. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Atrial Fibrillation
Recurrence
Incidence
Therapeutics
Confidence Intervals
Cryosurgery
Catheter Ablation
Pulmonary Veins
Sex Ratio
Tobacco Use

Keywords

  • Ablation
  • Atrial fibrillation
  • Atrial fibrillation arrhythmia
  • Catheter ablation
  • Cryoablation
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation : Insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial. / Andrade, Jason G.; Khairy, Paul; Macle, Laurent; Packer, Douglas L; Lehmann, John W.; Holcomb, Richard G.; Ruskin, Jeremy N.; Dubuc, Marc.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 7, No. 1, 2014, p. 69-75.

Research output: Contribution to journalArticle

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title = "Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: Insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial",
abstract = "Background-Early recurrence of atrial fibrillation (ERAF) is common after radiofrequency catheter ablation for AF. We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation. Moreover, the benefit of early reablation for ERAF after cryoballoon ablation is undetermined. Methods and Results-The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) trial randomized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation. Patients were followed for 12 months. ERAF was defined as any recurrence of AF >30 seconds during the first 3 months of follow-up. Late recurrence (LR) was defined as any recurrence of AF >30 seconds between 3 and 12 months. Of the 163 patients randomized to cryoablation, 84 patients experienced ERAF (51.5{\%}). The only significant factor associated with ERAF was male sex (hazard ratio [HR], 2.18; 95{\%} confidence interval [CI], 1.03-4.61; P=0.041). LR was observed in 41 patients (25.1{\%}), and was significantly related to ERAF (55.6{\%} LR with ERAF versus 12.7{\%} without ERAF; P<0.001). Among patients with ERAF, only current tobacco use (HR, 3.84; 95{\%} CI, 1.82-8.11; P<0.001) was associated with LR. Conversely, early reablation was associated with greater freedom from LR (3.3{\%} LR with early reablation versus 55.6{\%} without; HR, 0.04; 95{\%} CI, 0.01-0.32; P=0.002). Conclusions-ERAF after cryoballoon ablation occurs in ≈50{\%} of patients and is strongly associated with LR. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF.",
keywords = "Ablation, Atrial fibrillation, Atrial fibrillation arrhythmia, Catheter ablation, Cryoablation, Pulmonary vein isolation",
author = "Andrade, {Jason G.} and Paul Khairy and Laurent Macle and Packer, {Douglas L} and Lehmann, {John W.} and Holcomb, {Richard G.} and Ruskin, {Jeremy N.} and Marc Dubuc",
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T1 - Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation

T2 - Insights from the multicenter sustained treatment of paroxysmal atrial fibrillation (STOP AF) trial

AU - Andrade, Jason G.

AU - Khairy, Paul

AU - Macle, Laurent

AU - Packer, Douglas L

AU - Lehmann, John W.

AU - Holcomb, Richard G.

AU - Ruskin, Jeremy N.

AU - Dubuc, Marc

PY - 2014

Y1 - 2014

N2 - Background-Early recurrence of atrial fibrillation (ERAF) is common after radiofrequency catheter ablation for AF. We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation. Moreover, the benefit of early reablation for ERAF after cryoballoon ablation is undetermined. Methods and Results-The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) trial randomized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation. Patients were followed for 12 months. ERAF was defined as any recurrence of AF >30 seconds during the first 3 months of follow-up. Late recurrence (LR) was defined as any recurrence of AF >30 seconds between 3 and 12 months. Of the 163 patients randomized to cryoablation, 84 patients experienced ERAF (51.5%). The only significant factor associated with ERAF was male sex (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.03-4.61; P=0.041). LR was observed in 41 patients (25.1%), and was significantly related to ERAF (55.6% LR with ERAF versus 12.7% without ERAF; P<0.001). Among patients with ERAF, only current tobacco use (HR, 3.84; 95% CI, 1.82-8.11; P<0.001) was associated with LR. Conversely, early reablation was associated with greater freedom from LR (3.3% LR with early reablation versus 55.6% without; HR, 0.04; 95% CI, 0.01-0.32; P=0.002). Conclusions-ERAF after cryoballoon ablation occurs in ≈50% of patients and is strongly associated with LR. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF.

AB - Background-Early recurrence of atrial fibrillation (ERAF) is common after radiofrequency catheter ablation for AF. We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation. Moreover, the benefit of early reablation for ERAF after cryoballoon ablation is undetermined. Methods and Results-The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) trial randomized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation. Patients were followed for 12 months. ERAF was defined as any recurrence of AF >30 seconds during the first 3 months of follow-up. Late recurrence (LR) was defined as any recurrence of AF >30 seconds between 3 and 12 months. Of the 163 patients randomized to cryoablation, 84 patients experienced ERAF (51.5%). The only significant factor associated with ERAF was male sex (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.03-4.61; P=0.041). LR was observed in 41 patients (25.1%), and was significantly related to ERAF (55.6% LR with ERAF versus 12.7% without ERAF; P<0.001). Among patients with ERAF, only current tobacco use (HR, 3.84; 95% CI, 1.82-8.11; P<0.001) was associated with LR. Conversely, early reablation was associated with greater freedom from LR (3.3% LR with early reablation versus 55.6% without; HR, 0.04; 95% CI, 0.01-0.32; P=0.002). Conclusions-ERAF after cryoballoon ablation occurs in ≈50% of patients and is strongly associated with LR. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF.

KW - Ablation

KW - Atrial fibrillation

KW - Atrial fibrillation arrhythmia

KW - Catheter ablation

KW - Cryoablation

KW - Pulmonary vein isolation

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