Left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation: one-year clinical outcome after cryoballoon-based ablation

In this study, we sought to evaluate the safety and efficacy of cryoballoon (CB) based empirical left atrial appendage (LAA) isolation as an adjunct to pulmonary vein isolation (PVI) compared to the PVI-only strategy in patients with persistent AF.

Clinical outcomes of catheter ablation were less beneficial for persistent atrial fibrillation (AF) than paroxysmal AF.

A total of 100 consecutive patients with persistent AF underwent both PVI and additional LAA isolation using CB (Group II). As a control group (Group I), among persistent AF patients, we conducted a retrospective, propensity-score matched cohort, in whom only PVI was performed using CB. Recurrence of atrial tachyarrhythmia (Ata) at the 12th month follow-up was the primary endpoint. Baseline demographic and clinical characteristics were similar between two groups. At the 12th month follow-up, 67 (67%) patients in Group I and 86 (86%) patients in Group II were free of ATa after the index procedure (P < 0.001). As a unique complication of LAA isolation, left circumflex artery spasm was observed in 4% of the Group II. After adjusting for several baseline variables, PVI-only strategy was found as a significant predictor for recurrence (HR: 3.37; 95% CI: 1.73–6.56; P < 0.001). Transoesophageal echocardiography examination during the follow-up revealed no thrombus in the LAA.

Our findings indicated that LAA isolation as an adjunct to PVI improved 1-year outcomes in persistent AF compared with the PVI-only strategy using CB without an increase in thromboembolic complications.