Impact of NT-proBNP reduction on recurrence after cryoballoon pulmonary vein isolation and left atrial roof ablation in persistent atrial fibrillation

Pulmonary vein (PV) isolation by catheter ablation is a widely used curative therapy for atrial fibrillation (AF). However, in patients with persistent AF (PeAF), long-term outcomes are poor when PV isolation is performed alone. Although left atrial (LA) roof ablation is sometimes added to PV isolation, its effectiveness and predictors of success remain unclear. To identify predictors of arrhythmia recurrence in patients with PeAF undergoing LA roof ablation and PV isolation using a cryoballoon catheter. A retrospective assessment of LA roof ablation and PV isolation using a cryoballoon was performed in 65 consecutive patients with PeAF. The median age of the patients was 69 years [Q1:61, Q3:75]; 55% were female, and 49% had longstanding PeAF. The complete LA roof block success rate using a cryoballoon was 92.3%, with no esophagus-related complications. The 1-year post-ablation arrhythmia-free rate was 83.3%. Atrial arrhythmia recurrence was more common within the 3-month blanking period. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reduction rate ≥60.7% and sinus rhythm at 1-month post-ablation, and no arrhythmia during the 3-month blanking period strongly predicted arrhythmia-free status at 1 year post-ablation. In patients with PeAF who underwent LA roof ablation and PV isolation using a cryoballoon, the arrhythmia-free rate was high. The NT-proBNP reduction rate at 1-month post-ablation may serve as a simple and potentially useful predictor of procedural success.