title: Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation.
abstract: OBJECTIVE
  To assess the 1 year efficacy of pulmonary vein isolation (PVI) as index procedure for persistent atrial fibrillation (PersAF) comparing conventional radiofrequency irrigated-tip catheter ablation (RFCA) using contact-force technology and ablation using the second-generation cryoballoon (CB-AdvA).
  
  
  RESULTS
  One hundred consecutive patients (74 male, 74%; mean age 62.4 ± 9.6 years) with drug-refractory PersAF undergoing PVI using RFCA and CB-AdvA were enrolled. Follow-up was based on outpatient clinic visits including Holter-electrocardiograms. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 s. Among 100 patients, 50 underwent RFCA whereas 50 CB-AdvA. Mean procedure and fluoroscopy times were 90.5 ± 41.7 vs. 140.2 ± 46.9 min and 14.5 ± 6.6 vs. 19.8 ± 6.8 min in the CB-Adv and in the RFCA group, respectively (P < 0.01). At 1 year follow-up, after a 3 months blanking period (BP), freedom from ATas off-drugs after a single procedure was 60% (28/50 patients) in the CB-Adv and 56% (27/50 patients) in the RFCA group (P = 0.71). Multivariate analysis demonstrated that PersAF duration (P = 0.01) and relapses during BP (P = 0.02) were independent predictors of ATa recurrences following the index procedure.
  
  
  CONCLUSIONS
  Freedom from ATas following PersAF ablation with RFCA and CB-Adv is comparable at 1 year follow-up after a single procedure. Ablation with the CB-Adv is associated with shorter procedure time and radiation exposure as compared with RFCA. Atrial tachyarrhythmias occurrence during BP and longer time of PersAF seem to be significant predictors of arrhythmia recurrences after the index procedure.
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium g.ciconte@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Giannis
authors.initials: G
authors.lastname: Baltogiannis
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Juan
authors.initials: J
authors.lastname: Sieira
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Giovanni
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Ghazala
authors.initials: G
authors.lastname: Irfan
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Burak
authors.initials: B
authors.lastname: Hunuk
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cryoballoon ablation; One year follow-up; Persistent atrial fibrillation; Pulmonary vein isolation; Radiofrequency catheter ablation;; Second generation cryoballoon