Timing of early recurrence predicts long-term outcomes after cryoballoon pulmonary vein isolation

Adil K. Baimbetov, Kenzhebek A. Bizhanov, A Sarsenbayeva, N Bigeldiyev, A.V. Sapunov, D Abdimalikova

2026

Full text Open access: Hybrid Metadata (CSL-JSON)
DOI 10.1093/europace/euag105.473
Data confidence 70 medium
How this score is calculated

It is built from checkable properties of the record itself: whether the article has a DOI, how many independent sources confirmed its data, whether the required fields are filled in, and how recent the latest confirmation is. Disagreement between sources and a missing identifier lower it. A value of 80 or above means the record was published without further checking; 60 to 79 means it is published at reduced confidence, with a manual check advisable. A record verified by an editor by hand is never pushed below 90 by a recalculation. This scores our data about the article, not the article itself.

Abstract

Abstract Background Current guidelines recommend that atrial fibrillation (AF) recurrences within the first 90 days after pulmonary vein isolation (PVI) should not prompt immediate re-ablation; this period is therefore accepted as the "blanking period." However, accumulating data suggest that early atrial arrhythmia recurrences during this period may predict long-term outcomes. The optimal timing for considering re-ablation following early recurrence remains uncertain. Objective to evaluate whether the timing of early atrial arrhythmia recurrence during the 90-day blanking period after first-time CryoPVI predicts long-term procedural efficacy, and to determine when re-ablation should be considered. Methods We prospectively analyzed consecutive AF patients who underwent first-time cryoballoon PVI (CryoPVI) at a single center between 2019 and 2024. Patients were classified into four groups based on the timing of atrial arrhythmia recurrence during the blanking period: 0–30 days, 30–60 days, 60–90 days, and no recurrence within 90 days. CryoPVI was performed using a standardized protocol. Follow-up was conducted at 3, 6, 12, 18, 24, and 36 months. The primary efficacy endpoint was symptomatic atrial arrhythmia recurrence. Results A total of 1,222 patients underwent first-time CryoPVI. Early atrial arrhythmia recurrence occurred in 89 patients (7.3%) within 0–30 days, 44 patients (3.6%) within 30–60 days, and 41 patients (3.3%) within 60–90 days. Overall, 1,048 patients (85.8%) had no arrhythmia recurrence during the 90-day blanking period. At 36 months, the incidence of the primary efficacy endpoint was significantly higher among patients with early recurrence (0–30 days: 63.3%; 30–60 days: 71.6%; 60–90 days: 78.3%) compared with those without recurrence ≤90 days (42.3%; p < 0.0001). Conclusion Atrial arrhythmia recurrence during the first 90 days after CryoPVI is associated with significantly reduced long-term procedural efficacy. These findings suggest that re-ablation may be considered regardless of the timing of early recurrence within the blanking period.