title: A novel double cryoballoon strategy in persistent atrial fibrillation: a pilot study.
abstract: OBJECTIVE
  Cryoballoon technology is a promising technique in paroxysmal atrial fibrillation (AF) ablation. However, success rates in patients with persistent AF have not been convincing. There is a trend toward performing more extensive procedures that are referred to as 'pulmonary vein isolation plus.' To combine pulmonary vein isolation (PVI) and antral substrate modification, we used both the 23-mm and 28-mm cryoballoon in a single approach in patients with persistent AF.
  
  
  RESULTS
  33 consecutive patients (26 men, age 60 ± 10 years, LA size 44 ± 5 mm) with persistent AF were prospectively included. All patients underwent the "double balloon strategy:" at least two applications at each pulmonary vein (PV) using the smaller 23-mm balloon to isolate the PV at the ostial level plus at least one additional freeze by the 28-mm balloon at the wide PV antral level. 7-day Holter monitors were performed during follow-up at 1, 3, 6, 9, 12, 18 and 24 months post-ablation. 131 of 133 PVs were targeted and isolated (98.4 %). A mean of 14 ± 2 cryoballoon applications per patient or 3.5 ± 1.5 applications per vein were performed. After a single procedure and mean follow-up of 15 ± 3 months, 69.7 % of patients remained in sinus rhythm (3-month blanking period). There were no major complications.
  
  
  CONCLUSIONS
  In persistent AF, the "double balloon strategy;" combining the small and large cryoballoon allowed ostial PV isolation followed by antral cryoablation is feasible, safe and associated with a favorable outcome.
authors.affiliation: Department of Cardiology, Klinikum München-Bogenhausen, Englschalkingerstr. 77, 81925 Munich, Germany. mschmidtco@arcor.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt
authors.forename: Uwe
authors.initials: U
authors.lastname: Dorwarth
authors.forename: Florian
authors.initials: F
authors.lastname: Straube
authors.forename: Michael
authors.initials: M
authors.lastname: Wankerl
authors.forename: Jürgen
authors.initials: J
authors.lastname: Krieg
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Hans Ullrich
authors.initials: HU
authors.lastname: Ebersberger
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Armin
authors.initials: A
authors.lastname: Huber
authors.forename: Ernst
authors.initials: E
authors.lastname: Rummeny
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D017679:Cryotherapy / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome