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Pulmonary Vein Isolation Using a Second‐Generation Cryoballoon in Patients With Paroxysmal Atrial Fibrillation: One‐Year Outcome Using a Single Big‐Balloon 3‐Minute Freeze Technique
Author(s) -
MIYAZAKI SHINSUKE,
HACHIYA HITOSHI,
NAKAMURA HIROAKI,
TANIGUCHI HIROSHI,
TAKAGI TAKAMITSU,
HIRAO KENZO,
IESAKA YOSHITO
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13078
Subject(s) - medicine , pulmonary vein , paroxysmal atrial fibrillation , atrial fibrillation , balloon , cardiology , isolation (microbiology) , microbiology and biotechnology , biology
Cryoballoon Ablation of PAF Background The second‐generation cryoballoon (CB) has been recently introduced into clinical use for pulmonary vein isolation (PVI). Data on the feasibility, long‐term outcome, and optimal freeze cycle are still limited. We assessed the 1‐year clinical outcome after second‐generation CB ablation with single 3‐minute freeze techniques, and clinical variables associated with AF recurrence. Methods A total of 108 paroxysmal atrial fibrillation (PAF) patients undergoing cryothermal PVI were enrolled. PVI was performed with one 28‐mm CB using single 3‐minute freeze techniques without bonus applications. Fourteen‐day consecutive monitoring was done after discharge to detect early AF recurrences (ERAFs). Results Out of 425 PVs, 409 (96.2%) were isolated using exclusively CBs, and 16 required touch‐up ablation. Transient phrenic nerve injury, pericardial tamponade, and 50% PV stenosis occurred in 9, 1, and 1 patients, respectively. No PV stenosis >50% was observed in any patients. The total procedure and fluoroscopic times were 82.9 ± 26.4 and 26.2 ± 14.8 minutes, respectively. ERAFs were detected in 51 (47.2%) patients. At 1‐year after single and repeat procedures, 71.6% and 84.3% of the patients were free from recurrent AF off antiarrhythmic drugs (AADs), respectively. Eighteen patients underwent repeat procedures (median 6.0 [4.0–9.3] months post procedure), and 68.6% of PVs were still isolated. Cox's proportional models determined that ERAFs were significantly associated with AF recurrence (HR = 7.236; 95%CI = 2.753–19.016; P < 0.0001). AF‐freedom off AADs at 1‐year after single procedures was 90.8% and 50.3% in patients without and with ERAFs. Conclusions Second‐generation CB ablation using single 3‐minute freeze techniques appears feasible in PAF patients. ERAFs were significant factors for predicting clinical outcomes.