title: Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon.
abstract: BACKGROUND
  The cryoballoon technology has the potential to isolate a pulmonary vein (PV) with a single energy application. However, using the first-generation cryoballoon (CB-1G) repeated freezing or additional focal ablation is often necessary. The novel second-generation cryoballoon (CB-2G) features a widened zone of optimal cooling comprising the whole frontal hemisphere. The aim of this study was to investigate the impact of the novel design on procedural efficacy of cryoballoon PV isolation (CB-PVI).
  
  
  RESULTS
  Single transseptal CB-PVI using an endoluminal spiral mapping catheter was performed in 60 consecutive patients (CB-1G, 28 mm, 300 seconds application time: 30 patients; CB-2G, 28 mm, 240 seconds application time: 30 patients). When compared to the CB-1G, using the CB-2G increased single-shot PVI rate from 51% to 84% (P < 0.001) and decreased procedure duration (128 ± 27 vs 98 ± 30 minutes; P < 0.001), and fluoroscopy exposure time (19.5 ± 7.4 vs 13.4 ± 5.3 min; P = 0.001). Effective CB-2G PVI could be performed with increased real-time PVI visualization rate (49% vs 76%; P < 0.001). Time to PVI (T(PVI)) was shorter in the CB-2G group (79 ± 60 vs. 52 ± 36 seconds; P = 0.049). Procedure-related complications occurred in 2 patients in the CB-1G group and 1 patient in the CB-2G group.
  
  
  CONCLUSIONS
  The CB-2G significantly improved procedural efficacy compared to the CB-1G and provided reliable T(PVI) measurement. T(PVI) may be used to adjust application time and number individually in future studies. Final conclusions regarding the safety profile of the CB-2G requires additional research.
authors: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Frankfurt am Maim, Germany.
authors: Alexander
authors: A
authors: Fürnkranz
authors: Stefano
authors: S
authors: Bordignon
authors: Boris
authors: B
authors: Schmidt
authors: Melanie
authors: M
authors: Gunawardene
authors: Britta
authors: B
authors: Schulte-Hahn
authors: Verena
authors: V
authors: Urban
authors: Frank
authors: F
authors: Bode
authors: Bernd
authors: B
authors: Nowak
authors: Julian K R
authors: JK
authors: Chun
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011182:Postoperative Care; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery*