Multimorbidity increases risk of atrial fibrillation recurrence after cryoballoon ablation

Abstract Background Despite advancements in atrial fibrillation (AF) catheter ablation techniques, atrial arrhythmia recurrence after the procedure remains common, with rates estimated between 20% to 45%. While individual comorbidities have been shown to affect ablation outcomes, the influence of multimorbidity remains to be determined. Purpose This study aimed to investigate the association between multimorbidity and atrial arrhythmia recurrence after cryoballoon AF ablation. Methods The cryoballoon ablation study is a single-center, prospective registry which included 349 consecutive patients undergoing cryoballoon AF ablation between October 2018 and July 2023. The presence of eleven comorbidities was assessed, and the population was divided into two groups based on multimorbidity status: no multimorbidity (0-1 comorbidity) and multimorbidity (≥2 comorbidities). Clinical follow-up visits combined with 12-lead ECG and 24-hour Holter monitoring were scheduled at 3, 6 and 12 months post-procedure to capture the outcome of recurrence. The blanking period was defined as the first 8 weeks following the procedure. Cox proportional hazard regression analyses were conducted to assess the association between individual comorbidities and multimorbidity with atrial arrhythmia recurrence within one year post-ablation. Kaplan-Meier estimates for the cumulative risk of the first recurrence were calculated and plotted. Results The mean age was 62±9 years and 123 (35%) were women. Multimorbidity was present in 181 (52%) patients, with the most prevalent combinations being hypertension and hypercholesterolemia (30%), hypertension and obesity (21%), and hypertension and coronary artery disease (12%) (Figure 1). During a median follow-up of 328 [IQR 203-409] days, 114 patients (33%) experienced atrial arrythmia recurrence within one year after cryoballoon AF ablation. Cox proportional hazard regression analyses, adjusted for age and sex, revealed a significant association between multimorbidity (HR 1.64, 95% CI 1.12-2.39) and atrial arrhythmia recurrence. Furthermore, hypertension (HR 1.58, 95% CI 1.01-2.49) and obesity (HR 1.63, 95% CI 1.09-2.42) were associated with recurrence at one year post ablation. Kaplan-Meier estimates for the cumulative risk of the first recurrence stratified by multimorbidity status are shown in Figure 2. Conclusion In AF patients undergoing cryoballoon AF ablation, multimorbidity was associated with atrial arrhythmia recurrence within one year post-ablation. Further research is needed to determine the best treatment approach for patients with multimorbidity to improve their chances of a successful ablation.