title: Dual balloon size strategy for cryoisolation of the pulmonary veins in patients with atrial fibrillation: comparison of 23 and 28mm diameter cryoballoons.
abstract: BACKGROUND
  Systematic use of a 28mm balloon has been proposed for pulmonary vein cryoisolation in patients with atrial fibrillation.
  
  
  OBJECTIVE
  To assess the results of a dual balloon size strategy using a 23 or 28mm cryoballoon catheter for pulmonary vein isolation.
  
  
  METHODS
  A total of 118 patients (mean age 56 ± 10 years) with paroxysmal (n=85) or persistent atrial fibrillation (n=33) were enrolled. Patients with four pulmonary veins<20mm in diameter were isolated with a 23mm cryoballoon (n=29); patients with one pulmonary vein diameter ≥20mm were isolated with a 28mm cryoballoon (n=89).
  
  
  RESULTS
  No significant difference in procedural variables was observed between the two groups. AF-free survival, after a mean follow-up of 19.9 ± 5 months, was similar in the two groups (69% vs 62%; p=0.57 and between patients with paroxysmal atrial fibrillation (68% vs 68%; p=0.91) or persistent AF (75% vs 48%; p=0.60). AF duration before the ablation procedure (p=0.005) was an independent predictor of AF recurrence. Phrenic nerve palsy rate was not statistically different in the two groups (4 [14%] vs 9 [10%]; p=0.73). The temperature in the right superior pulmonary vein (p=0.008) was an independent predictor of phrenic nerve palsy. Five patients developed left atrial flutter with the 28mm diameter balloon versus none with the 23mm balloon.
  
  
  CONCLUSIONS
  A dual balloon size strategy was not associated with a lower AF-free survival or a higher procedure-related complication rate in patients in whom the 23mm balloon was used. Pulmonary vein isolation with a 23mm cryoballoon catheter appears to be an appropriate option in selected patients with small pulmonary vein diameters.
authors.affiliation: Service de cardiologie, centre hospitalier de Perpignan, 20, avenue du Languedoc, 66046 Perpignan cedex, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Nadji
authors.forename: Jean-Sylvain
authors.initials: JS
authors.lastname: Hermida
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kubala
authors.forename: Serge
authors.initials: S
authors.lastname: Quenum
authors.forename: Vincent
authors.initials: V
authors.lastname: Mouquet
authors.forename: Sarah
authors.initials: S
authors.lastname: Traullé
authors.forename: Laurent
authors.initials: L
authors.lastname: Leborgne
authors.forename: Geneviève
authors.initials: G
authors.lastname: Jarry
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation*; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome