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Cryoballoon ablation for paroxysmal atrial fibrillation: mid-term outcome evaluated by ECG monitoring with an implantable loop recorder.
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  • Riccardo Maj,
  • Sergio De Ceglia,
  • Elena Piazzi,
  • Mattia Pozzi,
  • Elisabetta Montemerlo,
  • Mirko Casiraghi,
  • Marianna Fienga,
  • Sara Gressoni,
  • Giovanni Rovaris
Riccardo Maj
San Gerardo Hospital
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Sergio De Ceglia
San Gerardo Hospital
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Elena Piazzi
San Gerardo Hospital
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Mattia Pozzi
San Gerardo Hospital
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Elisabetta Montemerlo
San Gerardo Hospital
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Mirko Casiraghi
San Gerardo Hospital
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Marianna Fienga
San Gerardo Hospital
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Sara Gressoni
San Gerardo Hospital
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Giovanni Rovaris
San Gerardo Hospital
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Abstract

BACKGROUND The success rate after cryoballoon ablation (CB-A) performed for paroxysmal atrial fibrillation (PAF) might be underestimated by traditional noninvasive monitoring techniques. The purpose of this study was to evaluate the mid-term outcome of CB-A in patients with PAF implanted with an implantable loop recorder (ILR) after the procedure. METHODS Between January 2017 and March 2019, all patients who underwent CB-A for PAF and who were subsequently implanted with an ILR were retrospectively included. All devices were equipped with remote monitoring. All ILR-documented atrial tachycardia (AT) or AF episodes ≥ 6 minutes were considered as recurrence; both true and false episodes were collected. A 3-month post-procedural blanking period (BP) was applied. RESULTS A total of 102 patients (77 male, mean age 60.6 ± 9.6 years) who underwent pulmonary vein isolation (PVI) by CB-A were included; mean time from first diagnosis of AF to PVI was 51.5 ± 46.9 months. Mean follow-up was 29.3 ± 8.1 months; at 12-month follow-up, the success rate was 64.7%, while at 2-year follow-up, freedom from AT/AF recurrences was achieved in 44.1% of the patients. In the follow-up, a total of 4987 ECG strips were analyzed; true-positive episodes were confirmed in 2026 cases (40.6%), while 2961 episodes (59.4%) were considered false-positive. CONCLUSION In patients with PAF implanted with an ILR, CB-A results in freedom from any AT/AF recurrence in 64.7% of patients at 12-month follow-up and in 44.1% of patients when evaluated at 2-year. Careful adjudication of all ILR-documented AF episodes is required to avoid misdiagnosis.

Peer review status:Published

13 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
14 Nov 2020Submission Checks Completed
14 Nov 2020Assigned to Editor
16 Nov 2020Reviewer(s) Assigned
18 Jan 2021Review(s) Completed, Editorial Evaluation Pending
20 Jan 2021Editorial Decision: Revise Minor
07 Feb 20211st Revision Received
11 Feb 2021Submission Checks Completed
11 Feb 2021Assigned to Editor
11 Feb 2021Reviewer(s) Assigned
19 Feb 2021Review(s) Completed, Editorial Evaluation Pending
21 Feb 2021Editorial Decision: Accept
18 Mar 2021Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.14998