Long-term incidence of cardioembolic events after cryoballoon pulmonary vein isolation

Background Long-term outcomes in term of cardioembolic events (CE) is poorly described after cryoballoon pulmonary vein isolation (cryo-PVI) for atrial fibrillation (AF). Purpose To evaluate the long-term incidence of CE after cryo-PVI. Methods All consecutive patients who underwent cryo-PVI for paroxysmal or persistent AF between November 2012 and October 2017 were included. They were prospectively followed at least 12 months in the ablation center, and then by their cardiologist. Decision of oral anticoagulation (OAC) discontinuation was let at the appreciation of the referent cardiologist. All ischemic events (stroke, transient ischemic attack (TIA), systemic embolism) were collected. Results Four hundred and fifty patients (78% men, median age 61 years) were included, among which 208 (46%) were initially in persistent AF. Median CHA2DS2-VASc score was 1 (IQR 1), and 26 patients (6%) had a history of stroke/TIA before the procedure. Two hundred and seventy patients (60%) were in sinus rhythm after one procedure and a median follow-up of 26 months (IQR 23). OAC was discontinued for 75 patients (17%) after the procedure, among which 50 (67%) had no indication for long-term anticoagulation. Six patients presented an ischemic event, all considered as cardioembolic origin: 3 stroke, 2 TIA, 1 acute lower limb ischemia. Mean follow-up was 30 months, therefore incidence of CE was 0.53%/year. Three out of six of the patient who presented CE had no recurrence documented before or at the time of the event. All patients who presented a CE had class I or class IIa indication for long-term anticoagulation. Conclusion In our cohort, long-term incidence of CE after cryo-PVI was 0.53%/year. Absence of documented recurrence could not be an argument for stopping OAC, decision who need to be guided only by CHA2DS2-VASc score.