title: Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients.
abstract: OBJECTIVE
  The purpose of this study was to investigate long-term outcomes of freedom from atrial fibrillation (AF) after pulmonary vein (PV) isolation using cryoballoon ablation with balloon-size selection based on individual PV diameters.
  
  
  BACKGROUND
  Data are lacking on long-term outcomes from cryoablation and on the most effective balloon size.
  
  
  METHODS
  This was a prospective observational study involving 605 consecutively enrolled patients with symptomatic paroxysmal AF (n = 579) or persistent AF. Cryoballoon size was based on magnetic resonance imaging and/or conventional angiograms. Patients were followed up every 3 months during the first year after discharge and every 6 months in the second year. After 24 months, follow-up was on an outpatient basis with documented AF episodes recorded.
  
  
  RESULTS
  The PV isolation was achieved without touch-up in 91.1% of patients, using the smaller balloon in 26.7%, the larger balloon in 25.6%, and both balloons in 47.7% of patients. Follow-up data for >12 months (median 30 months; interquartile range 18 to 48 months) were available for 451 patients, 278 (61.6%) of whom were free of AF recurrence with no need for repeat procedures after the 3-month blanking period. Rates of freedom from AF after 1, 2, and 3 repeat procedures (using cryoballoon or radiofrequency ablation with similar success rates) were 74.9%, 76.2%, and 76.9%, respectively. Use of the smaller balloons or both balloons produced the highest rates of long-term freedom from AF. Phrenic nerve palsy occurred in 12 patients (2%), resolving within 3 to 9 months.
  
  
  CONCLUSIONS
  Rates of long-term freedom from AF after cryoballoon ablation are similar to those reported for radiofrequency ablation. A choice between balloons may improve outcomes.
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. jvogt@hdz-nrw.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Vogt
authors.forename: Johannes
authors.initials: J
authors.lastname: Heintze
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Bogdan
authors.initials: B
authors.lastname: Muntean
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome