Empirical cryoballoon-based left atrial appendage isolation followed by closure, including cases with LAA thrombosis, in patients with persistent atrial fibrillation and durable pulmonary vein isolation: Feasibility and long-term outcomes (CB LAAI + LAAC after durable PVI in persistent AF)

Efe, TH; Ebrahimi, R; Schaack, D; Urbanek, L; Bordignon, S; Schmidt, B; Chun, JKR; Chen, S

doi:10.1016/j.hrthm.2025.12.004

Arrhythmias & electrophysiology

Empirical cryoballoon-based left atrial appendage isolation followed by closure, including cases with LAA thrombosis, in patients with persistent atrial fibrillation and durable pulmonary vein isolation: Feasibility and long-term outcomes (cryoballoon (CB) left atrial appendage isolation (LAAI) + left atrial appendage closure (LAAC) after durable PVI in persistent atrial fibrillation (AF))

Heart RhythmPublished 5 Dec 2025Prospective observational cohort study

Read the original article ↗PubMed

Cite

Authors' conclusion

Empirical CB LAAI followed by LAAC seems to be a feasible, safe, and effective strategy for patients with recurrent persistent AF after durable pulmonary vein isolation in an experienced center, offering a long-term therapeutic option for those at elevated thromboembolic and moderate bleeding risk.

Study context

Population: Patients with recurrent persistent AF after durable pulmonary vein isolation
Participants: 101 patients

Outcome: Feasibility, safety and long-term outcomes (arrhythmia recurrence, major adverse cardiac events)
Follow-up: 3 years

Methodological detailssingle-centre

Single-centre

Main finding

As reported in the abstract

Freedom from atrial tachyarrhythmia

Freedom from atrial tachyarrhythmia at 1 year

73%

Freedom from atrial tachyarrhythmia at 2 years

57%

Freedom from atrial tachyarrhythmia at 3 years

44%

Observational data: associations, not effects.

Further findings

Procedural outcomes

Durable LAAI achieved: 81.2%
Successful repeat isolation (patients): 19
LAAC performed (patients): 89
LAAC implantation success: 100%
Distal LAA thrombus detected; all underwent successful LAAC without embolic events: 10%

Safety

Periprocedural complications

Transient phrenic nerve palsy: 2%
Pericardial effusion: 1%
Groin hematoma: 1%
Femoral pseudoaneurysm: 1%
No periprocedural stroke, systemic embolism or death

Major adverse cardiac events · 3 years

Ischemic stroke/TIA: 2%
Major bleeding: 2%
Minor bleeding: 2%
All-cause mortality: 3%
No device-related thrombus observed

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Empirical cryoballoon-based left atrial appendage isolation followed by closure, including cases with LAA thrombosis, in patients with persistent atrial fibrillation and durable pulmonary vein isolation: Feasibility and long-term outcomes (CB LAAI + LAAC after durable PVI in persistent AF). Heart Rhythm. Published 5 December 2025. doi:10.1016/j.hrthm.2025.12.004

Read the original article ↗

Summarised from the published abstract; every number is checked against it