JACC Clin Electrophysiol. 2025;11(6):1234-1247.
Reduction of AF Burden After Cryoballoon Ablation in Patients With Early Persistent AF: The COOL-PER Trial.
제1저자 이소령 · 교신저자 최의근
소속 (9)
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: choiek17@snu.ac.kr.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
- Cardiac Arrhythmia Center, Heart Vascular and Stroke Institute, Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND Limited data exist on reducing the atrial fibrillation (AF) burden, the regression from persistent to paroxysmal AF, and symptom improvement after cryoablation in patients with persistent AF.
OBJECTIVES This study sought to evaluate the efficacy of cryoablation in reducing the AF burden, regression to paroxysmal AF, and symptom improvement in patients with early persistent AF.
METHODS This investigator-initiated, multicenter, and prospective cohort study enrolled the patients with early persistent AF (≤3 years). All patients were inserted an implantable loop recorder at the time of trial entry. AF burden (percentage of time in AF) and actual AF type were evaluated during pre-cryoablation and 12-month follow-up after cryoablation. AF-related symptoms and quality of life were assessed.
RESULTS A total of 130 patients were enrolled (median age 61 years [Q1-Q3: 54-67 years]; median duration of persistent AF 6 months [Q1-Q3: 4-10 months]). The mean AF burden before cryoablation was 77 ± 34% (25.4% of high-burden paroxysmal AF; 74.6% of implantable loop recorder-confirmed persistent AF), which was reduced to 9 ± 21% after 12-month follow-up (mean 68 ± 37% of AF burden reduction; P < 0.001). Of the total, 38.5% had no recurrence of AF, 43.1% had a recurrence of paroxysmal AF, and 18.5% had a recurrence of persistent AF. Among those with confirmed persistent AF at baseline, 76% of patients showed regression to paroxysmal AF or no recurrence. After cryoablation, 77% of patients improved AF-related symptoms and quality of life as assessed by 36-Item Short Form Survey questionnaires.
CONCLUSIONS In patients with early persistent AF, cryoablation significantly reduced AF burden and achieved regression of AF type followed by symptom improvement. (Cryoablation for Pulmonary Vein Isolation Alone in Patients with Early Persistent AF Assessed by Continuous Monitoring [COOL-PER]; NCT05507749).
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Keywords
cryoballoon ablationimplantable loop recorderpersistent atrial fibrillation
Conflict of interest statement
Funding Support and Author Disclosures This study was sponsored by Medtronic (IIS ERP-2020-12253). Dr Choi has received research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical, Daiichi-Sankyo, DeepQure, Dreamtech, Jeil Pharmaceutical, Medtronic, Samjinpharm, Samsung Electronics, Seers Technology, and Skylabs. Dr Lip has served as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Athos, and Daiichi-Sankyo (no fees are received personally); and has served as National Institute for Health and Care Research (NIHR) Senior Investigator and co-principal investigator of the AFFIRMO project on multimorbidity in atrial fibrillation (grant agreement no. 899871), TARGET project on digital twins for personalized management of atrial fibrillation and stroke (grant agreement no. 101136244), and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement no. 101080189), which are all funded by the European Union’s Horizon Europe Research and Innovation program. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
그 밖의 정보
- 출판 형태
- Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
- 저널
- JACC. Clinical electrophysiology · eISSN 2405-5018
- 전자 출판
- 2025-03-26
- MeSH
- Humans · Atrial Fibrillation* / surgery / physiopathology · Cryosurgery* / methods · Middle Aged · Male · Female · Aged · Prospective Studies · Quality of Life · Treatment Outcome
- 데이터
- ClinicalTrials.gov: NCT05507749