title: Pulmonary vein isolation with radiofrequency ablation followed by cryotherapy: a novel strategy to improve clinical outcomes following catheter ablation of paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Pulmonary vein (PV) isolation for atrial fibrillation (AF) often requires repeat procedures due to PV reconnection. We hypothesized that wide area cicumferential ablation using radiofrequency energy (RFA) followed by ostial PV ablation with a cryoablation balloon would reduce the rate of AF recurrence compared with either approach alone.
  
  
  RESULTS
  A retrospective study compared outcomes in the first 25 consecutive patients undergoing PV isolation for paroxysmal AF using the combined approach, to consecutive controls using either approach alone. Demographic and procedural data were collected from a prospective database. Kaplan-Meier curves were used to analyse AF free survival and curves were compared using the log-rank test. Twenty-five patients were included in each group. There were no major complications. Minor complications included two transient phrenic nerve palsies and a haematoma in both the combined groups and the cryoablation alone groups. In the RFA group the only complication was a grounding plate burn. Follow-up was 2.2 years in the RFA group, 1.0 years in the cryoablation group, and 1.4 years in the combined group. All recurrences but one occurred within one year. Freedom from AF was significantly greater in the combined group (80%) compared with the RFA alone group (52%) and the cryoablation alone group (56%, both P < 0.05).
  
  
  CONCLUSIONS
  The combined approach was safe and increased single procedure efficacy of PV isolation for AF compared with either technique alone.
authors.affiliation: Cardiology Research Department, Barts and The London NHS Trust and QMUL, St Bartholomew's Hospital, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A7BE, UK. mhtayebjee@hotmail.com
authors.forename: Muzahir H
authors.initials: MH
authors.lastname: Tayebjee
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.forename: Victoria
authors.initials: V
authors.lastname: Baker
authors.forename: Antonio
authors.initials: A
authors.lastname: Creta
authors.forename: Edward
authors.initials: E
authors.lastname: Duncan
authors.forename: Simon
authors.initials: S
authors.lastname: Sporton
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome