title: Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation.
abstract: BACKGROUND
  To prevent atrial fibrillation (AF) recurrence after catheter ablation, pulmonary venous isolation (PVI) at an antral level is more effective than segmental ostial ablation. Cryoablation around the pulmonary venous (PV) ostia for AF therapy is potentially safer compared to radiofrequency ablation (RFA). The aim of this study was to investigate the efficacy of a strategy using a large cryoablation balloon to perform antral cryoablation with 'touch-up' ostial cryoablation for PVI in patients with paroxysmal and persistent AF.
  
  
  METHODS
  Paroxysmal and persistent AF patients undergoing their first left atrial ablation were recruited. After cryoballoon therapy, each PV was assessed for isolation and if necessary, treated with focal ostial cryoablation until PVI was achieved. Follow-up with Holter monitoring was performed. Clinical outcomes of the cryoablation protocol were compared, with consecutive patients undergoing PVI by RFA.
  
  
  RESULTS
  124 consecutive patients underwent cryoablation. 77% of paroxysmal and 48% of persistent AF subjects were free from AF at 12 months after a single procedure. Over the same time period, 53 consecutive paroxysmal AF subjects underwent PVI with RFA and at 12 months, 72% were free from AF at 12 months (p=NS). There were too few persistent AF subjects (n=8) undergoing solely PVI by RFA as a comparison group. Procedural and fluoroscopic times during cryoablation were significantly shorter than RFA.
  
  
  CONCLUSIONS
  PV isolation can be achieved in less than 2 h by a simple cryoablation protocol with excellent results after a single intervention, particularly for paroxysmal AF.
authors.affiliation: Department of Cardiac Electrophysiology, St. Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK. pipin.kojodjojo@imperial.ac.uk
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
authors.forename: Phang Boon
authors.initials: PB
authors.lastname: Lim
authors.forename: Louisa
authors.initials: L
authors.lastname: Malcolm-Lawes
authors.forename: Zachary I
authors.initials: ZI
authors.lastname: Whinnett
authors.forename: Tushar V
authors.initials: TV
authors.lastname: Salukhe
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Linton
authors.forename: David
authors.initials: D
authors.lastname: Lefroy
authors.forename: Anthony
authors.initials: A
authors.lastname: Mason
authors.forename: Ian
authors.initials: I
authors.lastname: Wright
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Peters
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.forename: D Wyn
authors.initials: DW
authors.lastname: Davies
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
references.citation: Radiology. 2004 Mar;230(3):824-9
references.pmid: 14739316
references.citation: J Cardiovasc Electrophysiol. 2005 Mar;16(3):309-13
references.pmid: 15817092
references.citation: Pacing Clin Electrophysiol. 2008 Jan;31(1):112-20
references.pmid: 18181919
references.citation: Europace. 2008 Nov;10(11):1277-80
references.pmid: 18955410
references.citation: J Am Coll Cardiol. 2003 Aug 20;42(4):752-8
references.pmid: 12932615
references.citation: Eur Heart J. 2009 May;30(9):1105-12
references.pmid: 19270341
references.citation: J Am Coll Cardiol. 2008 Feb 26;51(8):850-5
references.pmid: 18294571
references.citation: Circulation. 2003 Nov 11;108(19):2355-60
references.pmid: 14557355
references.citation: Heart Rhythm. 2008 Jun;5(6):802-6
references.pmid: 18534363
references.citation: Pacing Clin Electrophysiol. 2008 Feb;31(2):235-44
references.pmid: 18233979
references.citation: Eur Heart J. 2007 Sep;28(18):2231-7
references.pmid: 17569680
references.citation: J Am Coll Cardiol. 2008 Jul 22;52(4):273-8
references.pmid: 18634982
references.citation: Eur Heart J. 2009 Mar;30(6):699-709
references.pmid: 19109353
references.citation: J Interv Card Electrophysiol. 2004 Oct;11(2):117-26
references.pmid: 15383774
references.citation: J Cardiovasc Electrophysiol. 2008 Sep;19(9):945-51
references.pmid: 18399966
references.citation: Heart Rhythm. 2009 Oct;6(10):1403-12
references.pmid: 19716348
references.citation: Heart Rhythm. 2008 Mar;5(3):353-60
references.pmid: 18313591
references.citation: Europace. 2008 Nov;10(11):1271-6
references.pmid: 18955409
references.citation: Heart Rhythm. 2006 Feb;3(2):140-5
references.pmid: 16443526
references.citation: J Interv Card Electrophysiol. 2009 Jun;25(1):59-65
references.pmid: 19148721
references.citation: Pacing Clin Electrophysiol. 2004 Apr;27(4):551-4
references.pmid: 15078415