The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2

Background Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15–40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI. Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI. Methods Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none ( N = 252 [31.4%]), 1 ( N = 255 [31.8%]), 2 ( N = 159 [19.8%]), and 3–4 ( N = 137 [17.1]). Results At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134–1.433; p