# Impacts of Premature Atrial Contractions and Biochemical Markers Early After Cryoballoon Versus Radiofrequency Ablation on the Late Recurrence of Atrial Fibrillation

## TL;DR

This study found that the number of premature atrial contractions after ablation, not biochemical markers, predicts late recurrence of atrial fibrillation, regardless of the ablation method used.

## Contribution

The study identifies PAC burden as a novel predictor of late AF recurrence, independent of ablation type.

## Key findings

- PAC burden was significantly associated with late AF recurrence in both cryoballoon and radiofrequency ablation groups.
- Biochemical markers like CK-MB and CRP were higher after cryoballoon ablation but did not predict late AF recurrence.
- Early AF recurrence during the blanking period was a strong predictor of late AF recurrence.

## Abstract

We sought to clarify the impacts of premature atrial contractions (PACs) and biochemical markers early after cryoballoon (CB) versus radiofrequency (RF) ablation for atrial fibrillation (AF) on the late recurrence of AF (LRAF). The study population included 138 patients who underwent first-time ablation for paroxysmal AF with CB (n = 69) or RF (n = 69). We compared the levels of the PAC burden on Holter monitoring, myocardial-bound creatine kinase (CK-MB), troponin T (TnT), and C-reactive protein (CRP) the day after ablation, and we assessed the incidence of LRAF, which was defined as AF after a 3-month blanking period. The postprocedural PAC burden was not significantly different between the CB and RF groups (P = .35), whereas the CK-MB and CRP levels were significantly higher in the CB group (both P < .01); the TnT levels of the groups were similar (P = .63). Among these, only a higher PAC burden was significantly associated with LRAF in both the CB (top quartile [≥2.16%]: 58% vs. others: 17%; log-rank P = .01) and RF (top quartile [≥3.05%]: 36% vs. others: 9%; log-rank P < .01) groups. A Cox regression analysis revealed two significant predictors of LRAF: in-hospital recurrence (CB group: hazard ratio [HR], 3.55 [1.67–11.80]; P = .04; RF group: HR, 7.55 [1.67–34.20]; P = .01) and a higher postprocedural PAC burden (CB: HR, 1.54 [1.06–2.22]; P = .02; RF: HR, 1.90 [1.16–3.35]; P = .01). In conclusion, irrespective of the ablation modality, the next-day PAC burden (but not the biochemical markers examined herein) is useful for predicting LRAF. Early AF recurrence should be considered a future risk even at the beginning of the blanking period.