title: Pulmonary vein isolation as index procedure for persistent atrial fibrillation: One-year clinical outcome after ablation using the second-generation cryoballoon.
abstract: BACKGROUND
  No data are available about the clinical outcome of pulmonary vein isolation (PVI) as an index procedure for persistent atrial fibrillation (PersAF) ablation using the second-generation cryoballoon (CB-Adv).
  
  
  OBJECTIVE
  The purpose of this study was to assess the 1-year efficacy of PVI as an index procedure for PersAF ablation using the novel CB-Adv.
  
  
  METHODS
  Sixty-three consecutive patients (45 male [71.4%], mean age 62.7 ± 9.7 years) with drug-refractory PersAF undergoing PVI using the novel CB-Adv were enrolled. Follow-up was based on outpatient clinic visits including Holter ECGs. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 seconds.
  
  
  RESULTS
  A total of 247 PVs were identified and successfully isolated with a mean of 1.7 ± 0.4 freezes. Mean procedural and fluoroscopy times were 87.1 ± 38.2 minutes and 14.9 ± 6.1 minutes, respectively. Among 26 of 63 patients (41.3%) presenting with AF at the beginning of the procedure, 7 of 26 (26.9%) converted to sinus rhythm during ablation. Phrenic nerve palsy occurred in 4 of 63 patients (6.3%). At 1-year follow-up, after a 3-month blanking period (BP), 38 of 63 patients (60.3%) were in sinus rhythm. Because of ATa recurrences, 9 patients underwent a second procedure with radiofrequency ablation showing a pulmonary vein reconnection in 4 right-sided PVs (44.4%) and 3 left-sided PVs (33.3%). Multivariate analysis demonstrated that PersAF duration (P = .01) and relapses during BP (P = .04) were independent predictors of AT recurrences.
  
  
  CONCLUSIONS
  At 1-year follow-up, freedom from ATas following PersAF ablation with the novel CB-Adv is 60%. Phrenic nerve palsy is the most common complication. PersAF duration and relapses during the BP appear to be significant predictors of arrhythmic recurrences.
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium. Electronic address: g.ciconte@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.affiliation: Cardiovascular Department, IRCCS Multimedica, Sesto S. Giovanni, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ottaviano
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Giannis
authors.initials: G
authors.lastname: Baltogiannis
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Juan
authors.initials: J
authors.lastname: Sieira
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Giovanni
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Ghazala
authors.initials: G
authors.lastname: Irfan
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Electrophisiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Storti
authors.affiliation: Cardiovascular Department, IRCCS Multimedica, Sesto S. Giovanni, Milan, Italy.
authors.forename: Annibale Sandro
authors.initials: AS
authors.lastname: Montenero
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D003452:Cryosurgery / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cryoballoon ablation; One-year follow-up; Persistent atrial fibrillation; Pulmonary vein isolation; Second-generation cryoballoon