Predictors of Early Versus Late Atrial Tachyarrhythmia Recurrence After Cryoballoon Ablation by Atrial Fibrillation Type

INTRODUCTION: Patient characteristics and predictors of early (ERAT) and late (LRAT) recurrence of atrial tachyarrhythmia by atrial fibrillation (AF) type after cryoballoon ablation (CBA) remain poorly defined. METHODS: Using the Korean Heart Rhythm Cryoballoon Registry (12 centers, 2018-2022), 2051 patients undergoing CBA for drug-refractory AF were stratified by AF type. ERAT was defined as atrial tachyarrhythmia within the 3-month blanking period and LRAT as recurrence beyond 3 months. Independent predictors of ERAT (all patients) and LRAT (patients without ERAT) were identified. RESULTS: ERAT occurred in 631 patients (30.8%; 17.6% in paroxysmal and 40.4% in persistent AF). Among 1420 patients without ERAT, LRAT occurred in 311 (21.9%; 16.7% paroxysmal, 27.2% persistent). In paroxysmal AF, coronary artery disease (HR 1.60; 95% CI, 1.00-2.56; p = 0.048) and LA enlargement (HR 1.07; 95% CI, 1.04-1.10; p < 0.001) predicted ERAT, whereas hypertrophic cardiomyopathy (HR 5.01; 95% CI, 2.20-11.42; p < 0.001) and LA enlargement (HR 1.04; 95% CI, 1.01-1.08; p = 0.019) predicted LRAT. In persistent AF, AF duration (HR 1.04; 95% CI, 1.02-1.06; p < 0.001) and LA enlargement (HR 1.03; 95% CI, 1.02-1.04; p < 0.001) predicted ERAT, and LA enlargement (HR 1.03; 95% CI, 1.01-1.05; p = 0.010) independently predicted LRAT. CONCLUSION: Predictors of ERAT and LRAT differed between patients with paroxysmal and those with persistent AF. LA enlargement was the most consistently shared predictor across recurrence phenotypes.