Comparison of Cryoballoon and Hybrid surgical Posterior Wall Isolation for Persistent Atrial Fibrillation to conventional ablation

Background: Optimalablation strategy for persistent atrial fibrillation (AF) is unclear;PWI of the left atrium may improve outcome.Our aim was to compare outcomes of posterior wall isolation (PWI) ablation for persistent AF achieved by cryoballoon ablation (CRYO) or hybrid surgical ablation (HABL) to matched patients undergoing conventional radiofrequency ablation (CRA).

Methods: In our single center retrospective study,patients underwent HABL and CRYO withcircumferential pulmonary vein ablation (CPVA),roof and floor lines to complete PW box lesion. CRA consisted of CPVA, roof line and lateral mitral isthmus line (MVI).

Results: Of 61 patients (mean duration of AF 1.3 ± 0.4 yrs)who underwent ablation, after follow-up of 366 ± 62 days, AF recurrence was 10.5% and 48% (p=0.001) and the need for repeat ablation 5% vs 30% (p=0.007) in PWI and CRA groups respectively, without a significant difference in incidence of AT/FL 18 vs 26 % or cardioversion 5.2 vs 7.1 %. Total procedure time and fluoroscopic time were 242 ±70 min vs 279 ±53 min (p=0.08) and 20±9 min vs 12 ± 4 min (p=0.003) for PWI and CRA respectively. CRYO had less AF recurrence and complications than HABL. Mean length of stayfor CRYO patients was 41 hrs compared to 145 hrs in HABL group, who underwent two procedures.

Conclusion: PWI in persistent AF patients decreases recurrence of AF and need for repeat procedure compared to CRA; PWI by CRYO is superior to HABL due to less LOS and complications.