title: Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Compared with the first-generation Arctic Front cryoballoon (ARC-CB), the new Arctic Front Advance cryoballoon (ARC-Adv-CB) increases the efficient CB-tissue contact surface during freezing, which may increase the incidence of phrenic nerve (PN) palsy (PNP).
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of paroxysmal atrial fibrillation (AF) ablation with the ARC-Adv-CB as well as the merits of a predictor of PNP.
  
  
  METHODS
  AF ablation was performed by using a "single 28-mm big CB" approach. The rate of pulmonary vein (PV) isolation with a first cryoapplication was measured. The distance between the CB and a PN pacing catheter in the superior vena cava was measured to predict PNP during freezing.
  
  
  RESULTS
  In 147 patients, PV were isolated with a single cryoapplication in 205 (81.3%) of 252 PV treated with the ARC-CB and in 280 (90.3%) of 310 PV treated with the ARC-Adv-CB (P = .003). The mean time to PV isolation was 52 ± 34 seconds and 40 ± 25 seconds (P < .001) and the temperature at the time of isolation was -36.1 ± 10.3°C and -32.3 ± 10.2°C (P = .001) in the ARC-CB and ARC-Adv-CB groups, respectively. Mean procedure and fluoroscopy durations were significantly shorter in the ARC-Adv-CB group. Transient PNP was observed in 7(10.6%) and 20(24.4%) of the patients treated with the ARC-CB and ARC-Adv-CB, respectively (P = .048). The distance between the lateral edge of the CB and a vertical line through the tip of the pacing catheter accurately predicted PNP (P < .001).
  
  
  CONCLUSIONS
  The 28-mm ARC-Adv-CB enabled more efficient ablation of paroxysmal AF and shorter procedures than did the ARC-CB. This higher performance was associated with a higher incidence of PNP, which was predicted by the distance between the CB and the PN.
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France. Electronic address: raphael.martins@chu-rennes.fr.
authors.forename: Raphaël P
authors.initials: RP
authors.lastname: Martins
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: David
authors.initials: D
authors.lastname: Hamon
authors.affiliation: Clinique Saint Gatien, Tours, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Césari
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: Albin
authors.initials: A
authors.lastname: Behaghel
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Behar
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; INSERM, U1099, Rennes, France; INSERM, CIC-IT 804, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Pavin
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010791:Phrenic Nerve / Q000293:injuries; D016896:Treatment Outcome
keywords: Cryoablation; Cryoballoon ablation; Paroxysmal atrial fibrillation; Phrenic nerve palsy; Pulmonary vein; Pulmonary vein isolation