Factors Associated with Documented Arrhythmia Recurrence After Cryoballoon Ablation in a Low-Risk Atrial Fibrillation Population Without Major Comorbidities

Background: Arrhythmia recurrence after cryoballoon ablation remains a clinically relevant problem in atrial fibrillation (AF). However, factors associated with documented recurrence in low-risk patients without major comorbidities are not well defined. This study aimed to evaluate factors associated with documented arrhythmia recurrence after cryoballoon ablation in a highly selected low-risk AF population. Methods: This retrospective study included 153 eligible patients selected from an institutional cryoablation database after application of predefined exclusion criteria. Only patients with a CHA₂DS₂-VA score ≤1 and without major comorbidities, including diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cerebrovascular disease, and heart failure, were included. Recurrence was defined as electrocardiographically documented AF or atrial tachyarrhythmia lasting ≥30 seconds after the 3-month blanking period during 1-year follow-up. Results: The study population included 70 women (45.8%) and 83 men (54.2%). Paroxysmal AF was present in 125 patients (81.7%), whereas 28 patients (18.3%) had persistent AF. Documented arrhythmia recurrence occurred in 40 patients (26.1%). Female sex was more frequent in the recurrence group than in the no-recurrence group (62.5% vs. 39.8%, p = 0.013). In the primary multivariable logistic regression model including sex, age, AF type, and left atrial diameter, female sex was associated with documented arrhythmia recurrence (OR 2.69, 95% CI 1.14–6.37; p = 0.024). Left atrial diameter showed a borderline association, and persistent AF showed numerically higher odds of recurrence; however, these variables did not reach conventional statistical significance in the primary model. Conclusion: In this selected low-risk cohort undergoing second-generation cryoballoon ablation, female sex was associated with documented arrhythmia recurrence during 1-year follow-up. This finding should be interpreted as hypothesis-generating and requires confirmation in larger prospective studies using standardized rhythm monitoring.