Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second-generation cryoballoon pulmonary vein isolation

Background: The prevalence and the clinical impact of conversion of atrial fibrillation (AF) to sinus rhythm (SR) during cryoballoon ablation (CB-A) are unknown.

Objective: The purpose of this study was to evaluate the prevalence of restoration of SR during CB-A and the clinical impact of this phenomenon.

Methods: Between January 2012 and September 2018, all patients who experienced conversion of AF to SR during CB-A were included. This group was subsequently matched for gender, age, type of AF, diagnosis-to-ablation time, and left atrial size with patients who underwent CB-A and did not experienced conversion of AF to SR. After discharge, patients were scheduled for follow-up visits at 1, 3, 6, and 12 months and 24 hours Holter recordings were obtained at each follow-up visit. All documented AF episodes of >30 seconds were considered as recurrence. A 3 month post-procedural blanking period (BP) was applied.

Results: A total of 1559 patients underwent pulmonary veins isolation by CB-A between January 2012 and September 2018; among them, 58 patients (3.7%) experienced restoration of SR during CB-A. In total, 53 patients (41 males [77.3%], mean age 61.4 ± 13.3 years) were included in the case group. During CB-A, restoration of SR occurred more frequently during right-side PVs applications (right inferior pulmonary vein 39.6%, right superior pulmonary vein 30.2%). If considering a BP, at 2 year follow-up, freedom from recurrences was 86.5% in the case group and 68.0% in the control group (P = .036).

Conclusion: Conversion of AF to SR is a favorable and relatively frequent phenomenon during cryoballoon pulmonary vein isolation ablation.