title: Isolating the pulmonary veins as first-line therapy in patients with lone paroxysmal atrial fibrillation using the cryoballoon.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Nowadays, catheter-based ablative approaches are mainly reserved for drug-refractory patients. However, the value of an ablative therapy as a first-line alternative remains elusive. The aim of our study was to analyse the acute procedural success and clinical outcome of patients with lone paroxysmal AF undergoing cryoballoon ablation (CBA) as first-line treatment.
  
  
  RESULTS
  Eighteen individuals (mean age 44 ± 9 years, range 23-61 years, 15 males) with lone paroxysmal AF preferring a catheter-based treatment to drug treatment as first-line therapy were consecutively enrolled in our study. Mean left atrial size was 39 ± 4 mm and mean left ventricular ejection fraction 58 ± 3%. After a mean of 2.4 CBA (range 2-4) applications pulmonary vein (PV) isolation could be demonstrated in 70 (97%) PVs. Additional lesions with a focal ablation catheter were needed to isolate one right inferior pulmonary vein and one left superior pulmonary vein in two different patients. At the end of the procedure, all (100%) PVs were isolated. After a 2-month blanking period, 16 patients (89%) were free of symptomatic AF recurrence at a mean follow-up of 14 ± 9 months and without antiarrhythmic drugs (AADs).
  
  
  CONCLUSIONS
  Cryoballoon ablation in patients with lone paroxysmal AF yields a high acute efficacy rate with a great chance of being free of symptomatic AF recurrence without antiarrhythmic drugs on a mid-term follow-up period, when offered as a first-line treatment.
authors.affiliation: Heart Rhythm Management Centre UZ Brussels, Brussels, Belgium. m.namdar@gmx.ch
authors.forename: Mehdi
authors.initials: M
authors.lastname: Namdar
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Westra
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorgente
authors.forename: Mark La
authors.initials: ML
authors.lastname: Meir
authors.forename: Fatih
authors.initials: F
authors.lastname: Bayrak
authors.forename: Jayakeerthi Y
authors.initials: JY
authors.lastname: Rao
authors.forename: Danilo
authors.initials: D
authors.lastname: Ricciardi
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.forename: Andrea
authors.initials: A
authors.lastname: Sarkozy
authors.forename: Joep
authors.initials: J
authors.lastname: Smeets
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult