Cryoballoon Ablation for the Treatment of Atrial Fibrillation in Patients With Concomitant Heart Failure and Either Reduced or Preserved Left Ventricular Ejection Fraction: Results From the Cryo AF Global Registry

BACKGROUND: Heart failure (HF) and atrial fibrillation (AF) often coexist; yet, outcomes of ablation in patients with AF and concomitant HF are limited. This analysis assessed outcomes of cryoablation in patients with AF and HF. METHODS AND RESULTS: The Cryo AF Global Registr y is a prospective, multicenter registr y of patients with AF who were treated with cryoballoon ablation according to routine practice at 56 sites in 26 countries. Patients with baseline New York Heart Association class I to III (HF cohort) were compared with patients without HF. Freedom from atrial arrhyth-mia recurrence ≥30 seconds, safety, and health care utilization over 12-month follow-up were analyzed. A total of 1303 patients (318 HF) were included. Patients with HF commonly had preser ved lef t ventricular ejection fraction (81.6%), were more of ten women (45.6% versus 33.6%) with persistent AF (25.8% versus 14.3%), and had a larger lef t atrial diameter (4.4±0.9 versus 4.0±0.7 cm). Serious procedure-related complications occurred in 4.1% of patients with HF and 2.6% of patients without HF (P=0.188). Freedom from atrial arrhythmia recurrence was not dif ferent between cohorts with either paroxysmal AF (84.2% [95% CI, 78.6– 88.4] versus 86.8% [95% CI, 84.2– 89.0]) or persistent AF (69.6% [95% CI, 58.1– 78.5] versus 71.8% [95% CI, 63.2– 78.7]) (P=0.319). Af ter ablation, a reduction in AF-related symptoms and antiarrhythmic drug use was observed in both cohorts (HF and no-HF), and freedom from repeat ablation was not dif ferent between cohorts. Persistent AF and HF predicted a post-ablation cardiovascular rehospitalization (P=0.032 and P=0.001, respecti vel y). CONCLUSIONS: Cryoablation to treat patients with AF is similarly effective at 12 months in patients with and without HF. REGISTRATION: URL: https://www.clini​caltr​ials.gov; Unique Identifier: NCT02752737.