Treatment of Long Persistent Atrial Fibrillation by Single Cryoballoon
Ablation of the Pulmonary Veins, Left Atrial Roof Line and Ablation of Left
Lateral Ridge From Within the Appendage
Estelle Torbey.MD, Valay Parikh.MD, Vratika Agarwal.MD, Soad Bekheit. MD, PhD, FACC,
FHRS, Marcin Kowalski.MD,FHRS
Staten Island University Hospital, New York
Background: Cryoballoon ablation has been validated as a successful modality for
treatment of paroxysmal atrial fibrillation.
Hypothesis: We hypothesized that ablation of long persistent atrial fibrillation utilizing
cryoballoon to isolate the pulmonary veins, cryoballoon ablation of the roof line and left
lateral ridge offers effective and safe approach to long persistent atrial fibrillation ablation.
Methods: Cryoballoon ablation was performed in 61 patients with long persistent Atrial
Fibrillation and the average age of 61 and CHADS2 of 1.1. Each patient underwent
cryoballoon pulmonary vein isolation. In each patient the left atrium was debulked by
applying cryoballoon to the left and right sides of the left atrial roof and cryoablation of the
left lateral ridge from within the left atrial appendage. The primary efficacy end point was
1-year recurrence rate. Patients were followed up every 3 months after discharge with
event monitor and some patients had loop recorder implanted.
Results: At one year, atrial fibrillation had recurred in 18 (34%) patients after the 3
months blanking period. The cumulative probability for freedom of recurrence at one year
was 66%. At one year all patients remained on anti-coagulation and 4 (9.7%) remained on
anti-arrhythmics. There was no significant complications.
Conclusion: A debulking of the left atrium with cryoballoon by performing pulmonary vein
isolation, roof line and cryoablation of the left lateral ridge is an effective therapeutic
strategy for treatment of long persistent atrial fibrillation with high single procedure
success rate after one year.