title: The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study.
abstract: OBJECTIVE
  Cryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, Cryocath) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether 'single big cryoballoon'-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).
  
  
  RESULTS
  After double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA-PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 +/- 9 years, LA size: 42 +/- 5 mm) with PAF (mean duration: 6.6 +/- 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q(1); Q(3)) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).
  
  
  CONCLUSIONS
  Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
authors.forename: Kyoung-Ryul Julian
authors.initials: KR
authors.lastname: Chun
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Roland
authors.initials: R
authors.lastname: Tilz
authors.forename: Thomas
authors.initials: T
authors.lastname: Zerm
authors.forename: Ilka
authors.initials: I
authors.lastname: Köster
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.forename: Buelent
authors.initials: B
authors.lastname: Koektuerk
authors.forename: Melanie
authors.initials: M
authors.lastname: Konstantinidou
authors.forename: Matthias
authors.initials: M
authors.lastname: Antz
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000503:physiopathology; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional