Europace. 2025;27(8):8243878.

Atrial fibrillation burden and symptom, quality of life, and healthcare resource utilization after cryoballoon ablation in persistent atrial fibrillation.

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제1저자 여무한, 이소령 · 교신저자 최의근, 온영근

PMID 40879123 PMC12395340 DOI 10.1093/europace/euaf150 IF 10.2 순환기내과

소속 (7)

Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Republic of Korea.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.

Abstract

AIMS To investigate the relationship between continuously monitored atrial fibrillation (AF) burden after cryoballoon ablation (CBA) and improvements in AF-related symptoms, quality of life (QoL), and AF-related healthcare resource utilization (HCRU) in early persistent AF.

METHODS AND RESULTS This secondary analysis of the multicentre COOL-PER trial included patients with early persistent AF who underwent CBA and continuous monitoring via an implantable loop recorder. Post-CBA AF burden was defined as the percentage of time in AF between 9- and 12-month after CBA, categorized as <0.1%, 0.1 to <10%, and ≥10%. Symptom improvement was assessed using the European Heart Rhythm Association symptom score and QoL with the SF-36 survey. AF-related HCRU was defined as rhythm control interventions after the 90-day blanking period and cardiovascular-related hospitalizations or emergency room visits. Among 130 patients (mean baseline AF burden 77 ± 34%), AF burden significantly decreased post-CBA, with 50.0% achieving <0.1%, 28.5% in 0.1 to <10%, and 21.5% ≥ 10%. Symptom improvement rate was highest in the <0.1% group (89.2%), followed by the 0.1 to <10% (78.4%) and ≥10% (46.4%) groups (P < 0.001). Significant QoL improvement was observed in the <0.1% and 0.1 to <10% groups but not in the ≥10% group. Rhythm control interventions and cardiovascular-related hospitalizations or emergency room visits were more frequent in the ≥10% group (29%, 43%) than in the 0.1 to <10% (5.4%, 22%) and <0.1% (1.5%, 7.7%) groups (both P < 0.001).

CONCLUSION In early persistent AF, lower AF burden 1-year post-CBA was associated with greater AF-related symptom improvement, significant QoL enhancement, and reduced HCRU during follow-up.

Keywords

Atrial fibrillationCryoablationImplantable ElectrodeQuality of Life

Figures

**Figure 1** Symptom changes by 1-year post-CBA AF burden. Proportion of patients with improved, unchanged, or worsened atrial fibrillation (AF)-related symptoms from baseline to 1-year follow-up, stratified by post-cryoablation (CBA) AF burden: < 0.1% (n = 65), 0.1% to <10% (n = 37), and ≥10% (n = 28). Symptom improvement, assessed using the EHRA score, was most common in the <0.1% burden group and least in the ≥10% group (P < 0.001). The proportion of patients with worsened or unchanged symptoms increased with higher AF burden (P = 0.023 and P = 0.001, respectively).

**Figure 2** Quality-of-life changes before and after CBA by 1-year post-CBA AF burden. Improvement in quality of life (QoL) as measured by the SF-36 questionnaire, including (A) total score, and (B) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Significant improvements were observed in the <0.1% and 0.1% to <10% AF burden groups (P < 0.05 for all measures), while the ≥10% burden group showed no statistically significant changes. Bars represent mean score differences with standard deviations; P-values based on paired comparisons from baseline to follow-up within each group.

**Figure 3** Healthcare resource utilization during 1-year follow-up post-CBA. Proportion of patients requiring atrial fibrillation–related healthcare resource utilization (HCRU) stratified by post-cryoablation (CBA) atrial fibrillation (AF) burden. Rhythm control interventions were counted only if performed after the 90-day post-ablation blanking period. The ≥10% group had significantly higher utilization of rhythm control interventions (29%) compared to the 0.1% to <10% (5.4%) and <0.1% (1.5%) groups (P < 0.001). This included a higher rate of direct current cardioversion (DCC, 14%) and redo AF ablation (14%) in the ≥10% group (P < 0.001 and P = 0.035, respectively). For cardiovascular (CV)-related hospitalizations and emergency room (ER) visits, the ≥10% group had a higher rate (43%) than the 0.1 to <10% group (22%) and the <0.1% group (9.2%) (P < 0.001). Hospitalizations were 43%, 22%, and 7.7%, and ER visits were 3.6%, 0%, and 1.5% in the ≥10%, 0.1 to <10%, and <0.1% groups, respectively (P < 0.001 and P = 0.5).

그림 출처: PubMed Central 공개 논문 (PMC12395340)

Conflict of interest statement

Conflict of interest: E.K.C.: Research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co., Daiichi-Sankyo, DeepQure, Dreamtech Co., Ltd., Jeil Pharmaceutical Co., Ltd, Medtronic, Samjinpharm, Samsung Electronics Co., Ltd., Seers Technology, and Skylabs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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