Abstract
ABSTRACT
Background
Contemporary Asian data on 24‐month outcomes after cryoballoon ablation (CBA) in predominantly paroxysmal atrial fibrillation (AF) are limited.
Methods
We conducted a multicenter registry across four Taiwanese tertiary centers (2018–2023). Consecutive patients undergoing CBA were analyzed for documented atrial‐arrhythmia recurrence (≥ 30‐s episodes after a 90‐day blanking period) and 12‐month quality of life (QoL; EQ‐5D‐3L index and visual analogue scale [VAS]). Rhythm follow‐up relied mainly on intermittent ECG, Holter, event‐recorder, or clinically indicated rhythm assessment. Cox models identified recurrence predictors; QoL analyses used paired complete‐case data.
Results
Among 298 patients (age 63.7 ± 11.8 years, 60% men), 282 (94.6%) had paroxysmal AF. Procedure‐related adverse events were rare (2.0%), with no tamponade or atrioesophageal fistula. Fifty‐eight patients (19%) had post‐blanking documented recurrence (late 90–365 days:
n
= 37; very late > 365 days:
n
= 21). Kaplan–Meier recurrence‐free survival under intermittent monitoring was approximately 90% at 12 months and 62% at 24 months, with wider confidence bands beyond 18 months. In multivariable analysis, longer time from AF diagnosis to ablation independently predicted recurrence (adjusted HR 1.050 per year, 95% CI 1.007–1.096;
p
= 0.023); left‐ventricular ejection fraction showed a borderline inverse association (adjusted HR 0.970 per 1%, 95% CI 0.942–1.000;
p
= 0.052). QoL analyses in 205/298 patients with paired data showed no significant change in EQ‐5D‐3L index (
p
= 0.672), but VAS categories shifted toward lower symptom burden (moderate/high 21.5% to 10.2%). A clinically meaningful VAS improvement (≥ 10 points) occurred in 34% (70/205). Because paired QoL data were incomplete and the logistic model was unstable owing to sparse events and quasi‐complete separation, no robust independent predictor of VAS improvement could be confirmed.
Conclusion
In this multicenter Taiwanese registry of predominantly paroxysmal AF, CBA had a low complication rate and high 12‐month freedom from documented arrhythmia under intermittent monitoring. Longer time from AF diagnosis to ablation was associated with recurrence. Among patients with paired QoL data, one‐third achieved clinically meaningful VAS improvement despite an unchanged EQ‐5D‐3L index.