title: Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?
abstract: BACKGROUND
  Relation between pre-procedural selection of patients and the success rate after a single cryoballoon ablation (CAB) procedure is unknown.
  
  
  METHODS
  CAB was performed in 378 (65% male, median age 58 years, 85% paroxysmal atrial fibrillation [AF]) consecutive patients with symptomatic and drug refractory AF. The combined ALARMEc (Atrial fibrillation type, Left Atrium size, Renal insufficiency, Metabolic syndrome, cardiomyopathy) risk score was calculated for each individual patient. The end-point of the study was the first AF, atrial flutter or atrial tachycardia recurrence after the 3-month blanking period in the 1-year follow-up since the index procedure, in the absence of anti-arrhythmic (class I and III) therapy.
  
  
  RESULTS
  Single and multi-catheter approach was used in 79% and 21% of patients, respectively. The acute success rate with single and multi-catheter approach was 79% and 99%, respectively. The overall 1-year success rate after a single CAB procedure was 70%. The 1-year outcome was: 83%, 70%, 60%, 40% and 29% in patients with ALARMEc risk score: 0, 1, 2, 3 and 5, respectively. Total rate of complications was 11%, including transient phrenic nerve palsy in 9.5% of cases.
  
  
  CONCLUSIONS
  Multi-catheter approach was needed in 21% of patients to achieve acute pulmonary vein isolation. Patients with low (≤ 1) ALARMEc risk score, preferably young individuals with sole paroxysmal AF (ALARMEc = 0), are best candidates for CBA procedure. Performing CBA in patients with higher (> 2) ALARMEc risk score should be avoided. Phrenic nerve palsy was a transient complication.
authors.forename: Maciej
authors.initials: M
authors.lastname: Wójcik
authors.forename: Alexander
authors.initials: A
authors.lastname: Berkowitsch
authors.forename: Sergey
authors.initials: S
authors.lastname: Zaltsberg
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Heinz F
authors.initials: HF
authors.lastname: Pitschner
authors.forename: Malte
authors.initials: M
authors.lastname: Kuniss
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. t.neumann@kerckhoff-klinik.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology; D018579:Patient Selection; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000503:physiopathology; D010791:Phrenic Nerve / Q000293:injuries / Q000503:physiopathology; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents