APCU25OS17 Evaluation of success rates and clinical outcomes of atrial fibrillation ablation in a tertiary center in Klang Valley

Introduction Atrial Fibrillation (AF) is a significant global health issue that requires a multidisciplinary approach, as outlined in European Society of Cardiology (ESC) guidelines and the Atrial Fibrillation Better Care (ABC) pathway. Its prevalence increases with age and is associated with comorbidities such as ischemic heart disease. Despite advances in ablation techniques, recurrence and complications remain concerns, particularly in the first year post-procedure. This study aimed to evaluate one-year clinical outcomes of AF ablation, identify predictors of recurrence, assess complication rates, and compare Wide Circumferential Ablation (WCA) with Cryoballoon Ablation (CRYO).Methods This longitudinal, observational study at a Malaysian tertiary center included patients undergoing WCA or CRYO. Baseline characteristics, procedural details, and follow-up at 6 months and 1 year were recorded. Statistical analysis was performed using SPSS.Results Thirty-eight patients underwent AF ablation (WCA n = 14, CRYO n = 24). Groups were similar at baseline except for higher hypertension prevalence in WCA (85.7% vs 50.0%, p = 0.028) and higher ischemic heart disease in CRYO (54.2% vs 21.4%, p = 0.049). In particular, CRYO achieved greater LA size reduction at 6 months (3.5 ± 0.6 cm vs 3.8 ± 0.7 cm, p = 0.018), with no difference at 1 year. At the same time, procedural success was high (WCA 86% vs CRYO 92%, p = 0.616), with low complication rates. Pericardial effusion occurred in 14% vs 4% (p = 0.542), and mortality in 14% vs 0% (p = 0.129). Meanwhile, AF recurrence was similar (50% vs 42%, p = 0.512). Predictors of recurrence were post-ablation Direct Current Cardioversion (DCCV) (OR 71.5, p = 0.028) and smaller LA size at 6 months (OR 0.002, p = 0.046). In addition, mortality correlated with procedural failure (r = –0.687, p < 0.01) and pericardial effusion (r = –0.536, p < 0.01). Moreover, EHRA scores improved at 6 months (p = 0.035) and 1 year (p < 0.001), whereas NYHA improved at 1 year (p = 0.007).Discussion Both WCA and CRYO achieved high procedural success with similar recurrence and complication rates. Specifically, CRYO demonstrated early reverse remodeling, while functional improvements occurred in both groups. On the one hand, recurrence was linked to DCCV requirement and larger LA size, underscoring the prognostic value of atrial remodeling. On the other hand, pericardial effusion, though rare, was associated with adverse outcomes and hyperthyroidism.Conclusion Overall, AF ablation was safe and effective, with significant symptomatic improvement over 1 year. Predictors of recurrence included DCCV requirement and persistent LA enlargement, supporting targeted follow-up. Thus, while CRYO may offer advantages in remodeling, both modalities provide comparable rhythm control and safety.