title: Inner lumen mapping catheter-facilitated big cryoballoon treatment for atrial fibrillation shortens procedural duration and fluoroscopic exposure with comparable mid-term efficacy.
abstract: OBJECTIVE
  This study aims to investigate whether the use of a novel inner lumen circular mapping catheter (IMC) can shorten the procedural duration and fluoroscopic exposure of the single transseptal big cryoballoon (CB) pulmonary vein isolation (PVI) procedures in patients with atrial fibrillation (AF).
  
  
  METHODS
  This is a prospective non-randomized case-control study. Forty-two patients (28 men, mean age 55.7 ± 12.1) with drug-refractory paroxysmal or persistent AF and underwent CB PVI procedures were divided into Group A (conventional single transseptal big CB approach, n = 21) and Group B (IMC-facilitated approach, n = 21). They were compared in the co-primary endpoints: (1) procedural duration and (2) fluoroscopic exposure and secondary endpoints: (1) 6-month AF-free survival and (2) number of cryo-applications.
  
  
  RESULTS
  Both the procedural duration (162 ± 26 vs. 215 ± 25 min; p < 0.001) and fluoroscopic exposure (44.1 ± 10.4 vs. 56.8 ± 11.7 min; p = 0.001) were significantly shorter in Group B than Group A patients. With multivariate stepwise regression, only the use of IMC was an independent predictor for procedural duration (β = -59; 95 % CI, -84.1 to -33.8; p < 0.001) and fluoroscopic exposure (β = -16.9; 95 % CI, -28.4 to -5.4; p = 0.006). The number of cryo-applications was significantly fewer in Group B than Group A patients (median 8 vs. 11; p = 0.001). There was no significant difference in the 6-month AF-free survival between the two approaches (57 % vs. 71 %; p = 0.351).
  
  
  CONCLUSIONS
  Compared to conventional single transseptal big CB PVI procedures, the use of IMC may reduce procedural duration, fluoroscopic exposure and the number of cryo-applications with comparable mid-term efficacy.
authors.affiliation: Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong. ngaiyinchan@yahoo.com.hk
authors.forename: Ngai-Yin
authors.initials: NY
authors.lastname: Chan
authors.forename: Ho-Chuen
authors.initials: HC
authors.lastname: Yuen
authors.forename: Pui-Shan
authors.initials: PS
authors.lastname: Chu
authors.forename: Chi-Chung
authors.initials: CC
authors.lastname: Choy
authors.forename: Hoi-Fan
authors.initials: HF
authors.lastname: Chow
authors.forename: Ho-Fai
authors.initials: HF
authors.lastname: Fong
authors.forename: Chun-Leung
authors.initials: CL
authors.lastname: Lau
authors.forename: Ying-Keung
authors.initials: YK
authors.lastname: Lo
authors.forename: Ping-Tim
authors.initials: PT
authors.lastname: Tsui
authors.forename: Suet-Ting
authors.initials: ST
authors.lastname: Lau
authors.forename: Ngai-Shing
authors.initials: NS
authors.lastname: Mok
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D062906:Cardiac Catheters; D003452:Cryosurgery / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011667:Pulmonary Veins / Q000601:surgery; D011829:Radiation Dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome