BACKGROUND AND OBJECTIVES:Thermal energy-based catheter ablation techniques, including cryoballoon ablation (CBA) and radiofrequency ablation (RFA), are widely utilized for rhythm control in patients with atrial fibrillation. However, direct comparisons of CBA and RFA using real-world data are limited. This study aims to evaluate the short- and long-term outcomes of CBA and RFA. METHODS:A total of 4,868 patients who underwent procedures between January 2018 and July 2022 were selected from the Korean CBA Registry and a multicenter RFA cohort. The primary outcome was the atrial tachyarrhythmia recurrence. To reduce selection bias, 1:1 propensity score matching (PSM) was performed, yielding 1,843 patients in each group. RESULTS:After PSM, RFA demonstrated significantly lower recurrence rates compared with CBA at both 1 year (20.9% vs. 27.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.61-0.79) and 3 years (31.9% vs. 35.2%; HR, 0.72; 95% CI, 0.65-0.81). In multivariable Cox regression analysis, RFA was independently associated with lower recurrence risk, with a 30% relative risk reduction at 1 year (HR, 0.70; 95% CI, 0.61-0.80) and a 27% relative risk reduction at 3 years (HR, 0.73; 95% CI, 0.65-0.81). When cavotricuspid isthmus (CTI) ablation was performed in addition to pulmonary vein isolation (PVI), recurrence rates were comparable between RFA and CBA. CONCLUSIONS:In this large, multicenter real-world cohort, RFA consistently demonstrated more favorable short- and long-term outcomes than CBA, even after PSM and multivariable adjustment. However, outcomes were comparable when CTI ablation was additionally performed, underscoring the importance of procedural strategies beyond PVI.

INTRODUCTION:Patient characteristics and predictors of early (ERAT) and late (LRAT) recurrence of atrial tachyarrhythmia by atrial fibrillation (AF) type after cryoballoon ablation (CBA) remain poorly defined. METHODS:Using the Korean Heart Rhythm Cryoballoon Registry (12 centers, 2018-2022), 2051 patients undergoing CBA for drug-refractory AF were stratified by AF type. ERAT was defined as atrial tachyarrhythmia within the 3-month blanking period and LRAT as recurrence beyond 3 months. Independent predictors of ERAT (all patients) and LRAT (patients without ERAT) were identified. RESULTS:ERAT occurred in 631 patients (30.8%; 17.6% in paroxysmal and 40.4% in persistent AF). Among 1420 patients without ERAT, LRAT occurred in 311 (21.9%; 16.7% paroxysmal, 27.2% persistent). In paroxysmal AF, coronary artery disease (HR 1.60; 95% CI, 1.00-2.56; p = 0.048) and LA enlargement (HR 1.07; 95% CI, 1.04-1.10; p < 0.001) predicted ERAT, whereas hypertrophic cardiomyopathy (HR 5.01; 95% CI, 2.20-11.42; p < 0.001) and LA enlargement (HR 1.04; 95% CI, 1.01-1.08; p = 0.019) predicted LRAT. In persistent AF, AF duration (HR 1.04; 95% CI, 1.02-1.06; p < 0.001) and LA enlargement (HR 1.03; 95% CI, 1.02-1.04; p < 0.001) predicted ERAT, and LA enlargement (HR 1.03; 95% CI, 1.01-1.05; p = 0.010) independently predicted LRAT. CONCLUSION:Predictors of ERAT and LRAT differed between patients with paroxysmal and those with persistent AF. LA enlargement was the most consistently shared predictor across recurrence phenotypes.

BACKGROUND:Identifying the risks related to the complications of electrical cardioversion (ECV) can alert the determinaton of rhythm control in patients with atrial fibrillation (AF). METHODS:We retrospectively reviewed 1,058 patients who underwent ECV for persistent or long-standing persistent AF/atrial flutter (AFL) from multiple centers. Patients were classified into the no-complication (1,023 patients) and complication (35 patients) groups based on the following major complications: stroke and/or systemic embolism (SSE), myocardial infarction, major bleeding, implantation of cardiac implantable electronic devices, ventricular tachycardia/fibrillation, and death at 1 year follow-up after ECV. RESULTS:Compared with the no-complication group, the complication group exhibited a higher proportion of female patients (37% vs. 22%), as well as a higher proportion of patients with older age (67 ± 11 vs. 61 ± 10 years), diabetes mellitus (DM) (49% vs. 24%), heart failure (HF) (49% vs. 30%), SSE (23% vs. 9%), high CHA₂DS₂-VASc (CV) score (3.6 ± 1.8 vs. 2.2 ± 1.4), low left ventricular ejection fraction (LVEF) (50 ± 16% vs. 58 ± 21%), and high left atrial volume index (LAVI) (51 ± 26 vs. 40 ± 20 mL/m²). Class I and III antiarrhythmics were less prescribed in the complication group than in the no-complication group (57% vs. 76%). Univariate analysis for complications revealed age (≥ 65 years), female sex, DM, HF, SSE, LVEF (< 50%), LAVI (≥ 40 mL/m²), CV score (≥ 3), bradycardia on Holter (< 60/min), and no antiarrhythmics as risk factors. Among these, multivariate analysis revealed clinical significance of female sex and SSE. CONCLUSION:Female sex and a history of SSE were the most important risk factors of complications in patients with persistent or long-standing persistent AF/AFL who underwent ECV.

BACKGROUND/AIMS:Identifying clinical risk factors of failed electrical cardioversion (ECV) for persistent or long-standing persistent atrial fibrillation (AF) can guide selection of rhythm control. METHODS:A total of 1058 patients who underwent ECV for persistent or long-standing persistent AF at multiple centres were retrospectively reviewed. Patients were divided into three groups: group 1 maintained sinus rhythm (SR) for >1 year, group 2 maintained SR ≤1 year after ECV, and group 3 had failed ECV. SR maintenance was assessed via regular electrocardiography follow-ups or Holter. RESULTS:Group 1, 2 and 3 comprised 315 (30%), 654 (62%), and 89 (8%) patients, respectively. The mean patient age was 61 ± 10 years, with males accounting for 78% (824). Group 3 showed longer AF duration, female dominance, high proportion of patients with history of coronary artery disease (CAD) and heart failure (HF), and increased left atrium (LA) diameter, LA volume index (LAVI), cardiac size, and cardiothoracic ratio. Univariate analysis revealed that AF duration (≥50 months), female sex, history of CAD and HF, increased LA diameter (≥ 45 mm) and LAVI (≥ 45 mL/m2), and no antiarrhythmics were risk factors of failed ECV for persistent or long-standing persistent AF. Among them, AF duration (≥50 months), history of HF, and increased LAVI showed clinical significance in the multivariate analysis. CONCLUSIONS:Longer AF duration, history of HF, and increased LAVI were strongly associated with failed ECV in patients with persistent or long-standing persistent AF.

BACKGROUND AND OBJECTIVES:The optimal sedation strategy for cryoablation in atrial fibrillation (AF) remains uncertain. We aimed to compare the safety and efficacy outcomes between deep sedation (DS) and general anesthesia (GA) in patients undergoing cryoablation. METHODS:We analyzed 2,068 patients from the Korean Heart Rhythm Society Cryoablation Registry who underwent cryoablation for AF between 2018 and 2022. Patients were grouped based on anesthesia method: DS (n=1,390) and GA (n=678). Propensity score matching (1:1) was performed to adjust for baseline differences. The primary outcomes included any recurrence of atrial tachyarrhythmias (ATs) after a 3 month blanking period and procedure-related major complications. RESULTS:The study included 2,068 patients (average age: 61.7±9.7 years; 76.3% male; 57.9% with persistent AF). In the matched cohort, AT recurrence rates were comparable between DS and GA groups (47.1% [n=220] vs. 53.1% [n=225]; p=0.99) during a mean follow-up of 1.2 years. The incidence of major complications was also similar between groups both before (2.8% [n=39] vs. 2.4% [n=16]; p=0.66) and after matching (2.3% [n=15] vs. 2.1% [n=14]; p=1.00). Subgroup analysis based on body mass index (≥30 vs. <30) revealed no significant differences in efficacy and safety outcomes between the DS and GA groups. CONCLUSIONS:DS provides a comparable safety and efficacy profile to GA for cryoablation in patients with AF. These findings support the use of DS as a feasible and practical alternative to GA in routine clinical practice.

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).

BACKGROUND:Pulsed field ablation (PFA) is a novel nonthermal ablation technique for atrial fibrillation, offering myocardial selectivity and a favorable safety profile. However, postprocedural pericarditis remains rarely reported. CASE SUMMARY:A 62-year-old man with paroxysmal atrial fibrillation underwent PFA with intracardiac echocardiography. Ablation was delivered at 2.0 kV, and postprocedural intracardiac echocardiography showed no pericardial effusion. Twelve hours later, the patient developed pleuritic chest pain. Electrocardiography showed PR-segment depression and diffuse ST-segment elevation. Transthoracic echocardiography revealed a 3-mm pericardial effusion, with elevated inflammatory biomarkers. Acute pericarditis was diagnosed, and the patient was treated with hydrocortisone, ibuprofen, and colchicine, resulting in symptom resolution within 4 weeks. DISCUSSION:Despite the nonthermal mechanism of PFA, acute pericarditis may occur as an early complication. Indirect myocardial inflammation and immune-mediated responses may contribute. Early recognition enables timely management. TAKE-HOME MESSAGES:Acute pericarditis can occur after PFA. Prompt anti-inflammatory therapy is essential for optimal outcomes.

Background/Aims Although an implantable loop recorder (ILR) is a valuable tool for investigation of unexplained syncope, there are limited data regarding time course to diagnosis and predictors of serious arrhythmias as a cause of unexplained syncope. We sought to investigate diagnosis rate by time period after ILR implantation and identify predictors of serious arrhythmias in patients with unexplained syncope. Methods We identified 394 patients who received ILR implantation for unexplained syncope enrolled in the Korean ILR registry. Results Serious arrhythmias were documented in 205 patients (52.0%). One hundred seventy-two patients (43.7%) had sick sinus-node syndrome (SSS), 24 (6.1%) had atrioventricular block, and nine (2.3%) had ventricular arrhythmia. Of these, 48 (23.4%) and 77 (37.6%) were diagnosed within two weeks and one month after ILR implantation, respectively. Median time to diagnosis was 62 days. In multivariable analysis, left atrial volume index (LAVI) ≥ 34 mL/m2 (hazard ratio [HR] 1.582), hypertension (HR 1.788), sinus bradycardia with a heartrate less than 60 beats per minute (HR 1.762), and LAVI ≥ 34 mL/m2 combined with sinus bradycardia (HR 1.911) were independent predictors of SSS. Cumulative detection rate of SSS was significantly higher in patients with LAVI ≥ 34 mL/m2 than those with LAVI < 34 mL/m2 (p < 0.001). Conclusions More than half of patients with unexplained syncope had serious arrhythmias, and more than one-third of these arrhythmias were diagnosed within one month after ILR implantation. LAVI combined with sinus bradycardia may be a useful predictor of SSS as a cause of unexplained syncope.

BACKGROUND AND OBJECTIVES:Cryoballoon ablation (CBA) is considered an effective rhythm control treatment for atrial fibrillation (AF) and is increasing exponentially. However, data regarding the efficacy and safety of CBA in elderly patients are limited. METHODS:A total of 2,652 patients (55.2% with non-paroxysmal AF) from the Korean CBA registry database with follow-up of ≥12-months after de novo CBA were divided into 2 groups based on age (<75 and ≥75 years old). Procedure related complications and clinical outcomes were compared. RESULTS:Compared to the control group (n=2,403), the elderly group (n=249) had female predominance (41.8% vs. 21.1%, p<0.001), a higher CHA₂DS₂-VASc scores (4.0 [3.0-5.0] vs. 2.0 [1.0-3.0]; p<0.001), and a higher prevalence of heart failure (33.3% vs. 21.9%; p<0.001) and chronic kidney disease (42.2% vs. 10.4%; p<0.001). A total of 120 procedure-related minor complications were reported, but no significant difference was observed between the 2 groups (6.4% vs. 4.3%; p=0.18). Recurrence of atrial tachyarrhythmias was observed in 67 patients (27.2%) in the elderly group and 788 patients (33.3%) in the control group. After adjusting for confounding variables, the freedom from atrial tachyarrhythmias during 24-month was similar between the 2 groups (67.0% vs. 62.7%; adjusted hazard ratio, 0.91; 95% confidence interval, 0.62-1.34; p=0.63). CONCLUSIONS:CBA showed a reasonable efficacy and safety profile in elderly population with AF, comparable to that in younger patients.

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.

BACKGROUND:A fixed-dose combination of rosuvastatin and amlodipine (Ros/Aml) offers a simplified approach to simultaneously address hypertension and dyslipidemia. While pivotal trials have demonstrated the efficacy and safety of this regimen, real-world evidence on its clinical outcomes related to major adverse cardiovascular and cerebrovascular events (MACCE) had been limited. METHODS:This multicenter, prospective, non-interventional study was conducted across 39 sites in South Korea (2020-2024) to evaluate the 12-month effectiveness and safety of Ros/Aml in adults with coexisting hypertension and dyslipidemia. The primary endpoint was the incidence of MACCE. Secondary endpoints included changes in blood pressure, lipid profiles, and safety outcomes. RESULTS:A total of 5018 patients were enrolled, with 5009 (99.82%) included in the Safety and Efficacy Sets. The mean age was 66.80 years, and 60.39% were male. In the efficacy set, the 12-month MACCE incidence was 0.54% [95% CI: 0.36-0.78], with no significant differences among four dose groups. Ros/Aml significantly reduced systolic and diastolic blood pressure at 6 and 12 months (both P < 0.001), and LDL-C levels (P < 0.0001). Adverse drug reactions were reported in 3.11% of patients; with only 0.06% experiencing serious ADRs and no ADR-related deaths occurred, suggesting a tolerable safety profile. CONCLUSIONS:In this large real-world study, Ros/Aml demonstrated a favorable safety profile and was effective in reducing MACCE risk, blood pressure, and lipid levels over 12 months. These findings in patients with hypertension and dyslipidemia support its use as a viable strategy for integrated cardiovascular risk management in clinical practice.

BACKGROUND AND OBJECTIVES:Atrial fibrillation (AF) occurs in more than 20% of hypertrophic cardiomyopathy (HCM) patients, further increasing the risk of stroke. Although radiofrequency catheter ablation in AF patients with HCM has been performed, data on cryoballoon ablation (CBA) in HCM patients are limited. We evaluated the efficacy and safety of CBA in HCM patients with AF. METHODS:The study included 2,649 patients with AF from the Korean CBA registry database with follow-up >12 months after de novo CBA. The primary efficacy outcome was recurrence of atrial tachyarrhythmias (ATs) ≥30s after a 3-month blanking period. RESULTS:Totals of 1,176 paroxysmal AF (44.4%) and 1,473 persistent atrial fibrillation (PeAF, 55.6%) patients (mean age 61.7 years; 76.7% men) underwent de novo CBA. Compared to non-HCM patients (n=2,590), those with HCM (n=59) had larger left atrium and higher prevalence of heart failure, previous stroke or transient ischemic attack, and PeAF. Procedure-related complications were not statistically different between the 2 groups. During a mean follow-up period of 638±308 days, 875 (33.0%) patients experienced recurrence of ATs (845 [32.6%] non-HCM patients and 30 [50.8%] HCM patients) (p=0.01). The overall AT-free survival rate at 2 years was 45.9% in HCM group and 63.3% in non-HCM group, respectively (p=0.014), whereas there was no significant difference between the two groups in PeAF. CONCLUSIONS:CBA may be an effective rhythm control treatment for patients with AF and HCM, with an AT-free survival rate of approximately 50% at 2-year follow-up and low procedure-related complications.

BACKGROUND AND OBJECTIVES:Atrial fibrillation (AF), the most common atrial arrhythmia (AA), is an increasing healthcare burden in Korea. The objective of this sub-analysis of the Cryo Global Registry was to evaluate long-term efficacy, symptom burden, quality of life (QoL), and healthcare utilization outcomes and factors associated with AA recurrence in Korean patients treated with cryoballoon ablation (CBA). METHODS:Patients were treated and followed up according to local standard-of-care in 3 Korean hospitals. Kaplan-Meier estimates were used in analyzing (1) efficacy defined as freedom from ≥30 second recurrence of AA at 24 months, (2) healthcare utilization, and (3) predictors of 24-month AA recurrence. Patient-reported QoL (using European Quality of Life-5 Dimensions-3 Levels) and predefined AF-related symptoms were assessed at baseline and 24-month follow-up. RESULTS:Efficacy was 71.9% in paroxysmal AF (PAF) and 49.3% in persistent AF (PsAF) patients (p<0.01). A larger left atrial diameter (LAD), an increased time from AF diagnosis to CBA, and PsAF were independent predictors of AA recurrence. The percentage of patients with no AF symptoms significantly increased from baseline (24.5%) to 24-month (89.5%) follow-up (p<0.01). Improvement in QoL from baseline to 24 months was not statistically different between AF cohorts. PAF patients experienced greater freedom from repeat ablations (93.9% vs. 81.4%) and cardiovascular hospitalizations (91.3% vs. 72.5%, p<0.001 for both). CONCLUSIONS:In alignment with global outcomes, CBA is an effective treatment for AF in the Korean population, with patients possessing a large LAD and not receiving ablation soon after diagnosis being the most at risk for AA recurrence. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02752737.

INTRODUCTION:Little is known about age and clinical intervention after implantable loop recorder (ILR) insertion. This study investigated the association between age and clinical intervention after ILR implantation. METHODS AND RESULTS:Data were obtained from a multicenter registry of ILR in Korea (2017-2020, n = 795). ILRs were inserted with indications of unexplained syncope, recurrent palpitation, or cryptogenic stroke. The primary outcome was clinically actionable event that was a composite of the newly detected atrial fibrillation (AF), pacemaker or implantable cardioverter defibrillator (ICD) implantation, catheter ablation, and anticoagulation initiation. The mean age was 64.3 years, and the mean follow-up duration was 20.6 months. Clinically actionable events were observed in 322 (40.5%) patients. Compared to younger age (< 50 years), older age (≥ 50 years) showed higher prevalence of newly detected AF (3.7% vs. 15.8%; p = 0.001), pacemaker implantation (11.2% vs. 21.2%; p = 0.022), and initiation of anticoagulation (3.7% vs. 18.6%; p < 0.001). No significant differences were found in ICD implantation (1.9% vs. 1.3%; p = 0.996) or catheter ablation (3.8% vs. 6.0%; p = 0.512). The older age group more frequently experienced clinically actionable events compared to the younger age group (hazard ratio 2.52, 95% confidence interval: 1.86-3.41; p < 0.001). A significant association was found in the increase of age (per 1-year) and the risk of clinically actionable events (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.04; p < 0.001). CONCLUSION:Advanced age is a significant risk factor for clinical intervention after ILR insertion. ILR should be considered more actively in older patients requiring prolonged rhythm monitoring.

BACKGROUND AND OBJECTIVES:Several real-world studies have been done in patients with nonvalvular atrial fibrillation (NVAF); however, information on its safety profile in patients with renal impairment is limited. XARENAL, a real-world study, aimed to prospectively investigate the safety profile of rivaroxaban in patients with NVAF with renal impairment (creatinine clearance [CrCl], 15-49 mL/min). METHODS:XARENAL is an observational single-arm cohort study in renal impairment NVAF patients. Patients were followed up approximately every 3 months for 1 year or until 30 days following early discontinuation. The primary endpoint was major bleeding events. All adverse events, symptomatic thromboembolic events, treatment duration, and renal function change from baseline were the secondary endpoints. RESULTS:XARENAL included 888 patients from 29 study sites. Overall, 713 (80.3%) had moderate renal impairment (CrCl, 30-49 mL/min), and 175 (19.7%) had severe renal impairment (CrCl, 15-29 mL/min) with a mean estimated glomerular filtration rate (eGFR) of 45.2±13.0 mL/min/1.73 m². The mean risk scores were 3.3±1.4 and 1.7±0.9 for CHA₂DS₂-VASc score and HAS-BLED score, respectively. An incidence proportion of 5.6% (6.2 events per 100 patient-years) developed major bleeding; however, fatal bleeding occurred in 0.5% (0.5 events per 100 patient-years). The mean change in the eGFR was 2.22±26.47 mL/min/1.73 m² per year. CONCLUSIONS:XARENAL observed no meaningful differences in major bleeding events from other previous findings as well as renal function changes in rivaroxaban-treated NVAF patients with renal impairment, which is considered to be acceptable in clinical practice. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03746301.

INTRODUCTION:The impact of early recurrence of atrial tachyarrhythmia (ERAT) within the 90-day blanking period on long-term outcomes in atrial fibrillation (AF) patients undergoing cryoballoon ablation (CBA) is controversial. This study aimed to assess the relationship between ERAT and late recurrence of atrial tachyarrhythmia (LRAT) post-CBA. METHODS:Utilizing data from a multicenter registry in Korea (May 2018 to June 2022), we analyzed the presence and timing of ERAT (<30, 30-60, and 60-90 days) and its association with LRAT risk after CBA. LRAT was defined as any recurrence of AF, atrial flutter, or atrial tachycardia lasting more than 30 s beyond the 90 days. RESULTS:Out of 2636 patients, 745 (28.2%) experienced ERAT post-CBA. Over an average follow-up period of 21.2 ± 10.3 months, LRAT was observed in 874 (33.1%) patients. Patients with ERAT had significantly lower 1-year LRAT freedom compared to those without ERAT (42.6% vs. 85.5%, p < .001). Multivariate analysis identified ERAT as a potential predictor of LRAT, with a hazard ratio (HR) of 3.98 (95% confidence interval [CI], 3.47-4.57). Significant associations were noted across all examined time frames (HR, 3.84; 95% CI, 3.32-4.45 in <30 days, HR, 5.53; 95% CI, 4.13-7.42 in 30-60 days, and HR, 4.29; 95% CI, 3.12-5.89 in 60-90 days). This finding was consistently observed across all types of AF. CONCLUSION:ERAT during the 90-day blanking period strongly predicts LRAT in AF patients undergoing CBA, indicating a need to reconsider the clinical significance of this period.

INTRODUCTION:Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) is considered an effective primary strategy for early persistent atrial fibrillation (AF). However, data regarding CBA for long-standing persistent AF (PeAF) are limited. We evaluated the efficacy and safety of CBA for long-standing PeAF compared to PeAF. METHODS:The study included 1484 patients with non-paroxysmal AF from Korean CBA registry data with follow-up of > 12 months after de novo CBA. The primary outcome was recurrence of atrial tachyarrhythmias (ATs) of ≥ 30-s after a 3-month blanking period. RESULTS:A total of 367 PeAF (25%) and 1117 long-standing PeAF (75.3%) patients (mean age 61.9 ± 9.6 years, 80% men) underwent de novo CBA. Compared to patients with PeAF, patients with long-standing PeAF had more heart failure, previous stroke or transient ischemic attack, chronic kidney disease, higher CHA2DS2-VASc score, and larger left atrium (LA). During a mean follow-up period of 15.1 ± 10.9 months, ATs recurrence occurred in 41.4% of PeAF and 40.1% of long-standing PeAF. Multivariate analysis showed that female gender (hazard ratio [HR]: 1.31, p = 0.01), larger LA ≥ 45 mm (HR: 1.53, p < .001) and LA volume index ≥ 51 mL/m2 (HR: 1.77, p < 0.001), and longer AF duration ≥ 5 years (HR: 1. 33, p = .003) were associated with ATs recurrence. After propensity score matching, larger LA was an independent factor for ATs recurrence. CONCLUSIONS:During a long-term follow-up period after index CBA in patients with non-paroxysmal AF, ATs recurrence rate was similar between PeAF and long-standing PeAF. CBA might be an effective strategy as an initial rhythm control therapy regardless of AF type.

Background and Objectives: Although a single -lead electrocardiogram (ECG) patch may provide advantages for detecting arrhythmias in outpatient settings owing to user convenience, its comparative effectiveness for real-time telemonitoring in inpatient settings remains unclear. We aimed to compare a novel telemonitoring system using a single -lead ECG patch with a conventional telemonitoring system in an inpatient setting. Methods: This was a single -center, prospective cohort study. Patients admitted to the cardiology unit for arrhythmia treatment who required a wireless ECG telemonitoring system were enrolled. A single -lead ECG patch and conventional telemetry were applied simultaneously in hospitalized patients for over 24 hours for real-time telemonitoring. The basic ECG parameters, arrhythmia episodes, and signal loss or noise were compared between the 2 systems. Results: Eighty participants (mean age 62 +/- 10 years, 76.3% male) were enrolled. The three most common indications for ECG telemonitoring were atrial fibrillation (66.3%), sick sinus syndrome (12.5%), and atrioventricular block (10.0%). The intra-class correlation coefficients for detecting the number of total beats, atrial and ventricular premature complexes, maximal, average, and minimal heart rates, and pauses were all over 0.9 with p values for reliability <0.001. Compared to a conventional system, a novel system demonstrated significantly lower signal noise (median 0.3% [0.1-1.6%] vs. 2.4% [1.4-3.7%], p<0.001) and fewer episodes of signal loss (median 22 [2-53] vs. 64 [22-112] episodes, p=0.002). Conclusions: The novel telemonitoring system using a single -lead ECG patch offers performance comparable to that of a conventional system while significantly reducing signal loss and noise. Trial Registration: Clinical Research Information Service Identifier: KCT0008176