Predictors of Recurrence and Quality of Life After Cryoballoon Ablation in Atrial Fibrillation: Data From a Multicenter Taiwanese Registry With 24‐Month Follow‐Up

BACKGROUND: Contemporary Asian data on 24-month outcomes after cryoballoon ablation (CBA) in predominantly paroxysmal atrial fibrillation (AF) are limited. METHODS: We conducted a multicenter registry across four Taiwanese tertiary centers (2018-2023). Consecutive patients undergoing CBA were analyzed for documented atrial-arrhythmia recurrence (≥ 30-s episodes after a 90-day blanking period) and 12-month quality of life (QoL; EQ-5D-3L index and visual analogue scale [VAS]). Rhythm follow-up relied mainly on intermittent ECG, Holter, event-recorder, or clinically indicated rhythm assessment. Cox models identified recurrence predictors; QoL analyses used paired complete-case data. RESULTS: Among 298 patients (age 63.7 ± 11.8 years, 60% men), 282 (94.6%) had paroxysmal AF. Procedure-related adverse events were rare (2.0%), with no tamponade or atrioesophageal fistula. Fifty-eight patients (19%) had post-blanking documented recurrence (late 90-365 days: n = 37; very late > 365 days: n = 21). Kaplan-Meier recurrence-free survival under intermittent monitoring was approximately 90% at 12 months and 62% at 24 months, with wider confidence bands beyond 18 months. In multivariable analysis, longer time from AF diagnosis to ablation independently predicted recurrence (adjusted HR 1.050 per year, 95% CI 1.007-1.096; p = 0.023); left-ventricular ejection fraction showed a borderline inverse association (adjusted HR 0.970 per 1%, 95% CI 0.942-1.000; p = 0.052). QoL analyses in 205/298 patients with paired data showed no significant change in EQ-5D-3L index (p = 0.672), but VAS categories shifted toward lower symptom burden (moderate/high 21.5% to 10.2%). A clinically meaningful VAS improvement (≥ 10 points) occurred in 34% (70/205). Because paired QoL data were incomplete and the logistic model was unstable owing to sparse events and quasi-complete separation, no robust independent predictor of VAS improvement could be confirmed. CONCLUSION: In this multicenter Taiwanese registry of predominantly paroxysmal AF, CBA had a low complication rate and high 12-month freedom from documented arrhythmia under intermittent monitoring. Longer time from AF diagnosis to ablation was associated with recurrence. Among patients with paired QoL data, one-third achieved clinically meaningful VAS improvement despite an unchanged EQ-5D-3L index.