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.