Introduction
Atrial fibrillation (AF) and heart failure are both emerging epidemics
and frequently occur together1-3. Whilst previously
considered a passive bystander in the setting of heart failure, AF is
now recognised as an active determinant of clinical
outcome4, 5 and not infrequently, the primary driver
of the heart failure itself6, 7. Recently, catheter
ablation of AF has established itself as an effective approach to the
restoration of sinus rhythm in patients with heart failure without
reliance upon long term anti-arrhythmic therapy, with several randomised
studies showing improvements in ventricular function6,
8, 9, symptoms10, reduced hospitalisations and
mortality8.
Although cryoablation has rapidly evolved as a mainstream treatment for
AF in the paroxysmal phenotype, its role in the setting of persistent AF
and particularly in those with structural heart disease remains largely
unexplored. Given that there is limited evidence for a lesion set beyond
pulmonary vein isolation at the index procedure, cryoablation may be a
feasible first line therapy in this cohort. We report long-term outcomes
in patients with heart failure undergoing index ablation with
cryoablation.