title: High rate of durable pulmonary vein isolation after second-generation cryoballoon ablation: analysis of repeat procedures.
abstract: OBJECTIVE
  Pulmonary vein isolation (PVI) using the first-generation cryoballoon (CB1) was characterized by a high rate of recovered pulmonary vein (PV) conduction along with a typical conduction gap pattern in patients with recurrent atrial tachyarrhythmia (ATa). Second generation (CB2) enables more uniform freezing. However, the rate of chronic PVI and PV conduction gap pattern is unknown.
  
  
  RESULTS
  All patients with ATa recurrence undergoing a second procedure after CB2 or (historical) CB1 PVI (28 mm) were enrolled. In all patients, a left atrial three-dimensional electronatomic reconstruction was performed. The rates of chronic PVI and localization of PV conduction gaps were determined and compared between CB1 and CB2. Antral PV re-isolation was performed using irrigated-tip radiofrequency current energy ablation. Of 206 patients (CB2), 18 patients underwent the repeat procedure after 192 (75:245) days. In 6 of 18 (33%) patients, all PVs were electrically isolated whereas in the remaining 12 patients (66%) at least one PV demonstrated PV reconduction. Of 71 PVs [1 left common PV (LCPV)], 55 PVs (77%) were chronically isolated. The right superior PV (RSPV) was characterized by the lowest rate of chronic PVI (RSPV: 56%, LSPV: 76%, RIPV: 83%, LIPV: 94%, LCPV: 100%). Compared with CB1, CB2 ablation resulted in a significantly higher rate of chronic PVI (CB2: 77% vs. CB1: 32%; P < 0.0001) with the greatest improvement along both inferior PVs.
  
  
  CONCLUSIONS
  Second-generation cryoballoon atrial fibrillation ablation is associated with a high rate of durable PVI in patients with ATa recurrence. The RSPV represents the PV with the greatest risk for left atrium-pulmonary vein reconnection.
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bordignon
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dugo
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Konstantinou
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Nowak
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Schulte-Hahn
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: CCB-Cardioangiologisches Centrum Bethanien, Markuskrankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt Am Main, Germany j.chun@ccb.de.
authors.forename: Kyoung Ryul Julian
authors.initials: KR
authors.lastname: Chun
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation; D016208:Databases, Factual; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cryoablation; PV reconduction