title: Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) Study.
abstract: BACKGROUND
  Pulmonary vein (PV) reconnection remains the most important cause of AF recurrence after AF ablation. The second-generation cryoballoon catheter's ability to achieve durable PV isolation was assessed in a prospective nonrandomized clinical trial.
  
  
  RESULTS
  PV isolation was performed by 4-minute ablations. Following verification of electrical isolation by a multielectrode mapping catheter, 1 additional lesion per PV was applied. Esophageal temperatures were monitored and all patients underwent postprocedure esophageal endoscopy. All patients underwent a second PV remapping procedure at ∼3 months to assess for PVI durability. Eighty-four (100%) veins were acutely isolated using only the 28 mm cryoballoon in 21 consecutive PAF patients with 2.2 ± 0.6 cryoapplications per vein, with the majority (83%) occurring after a single freeze. One patient presented with hematemesis and an esophageal ulceration that was treated conservatively; there were no episodes of esophageal fistula or phrenic nerve palsy. At 3.4 (2.9-4.1) months postablation, 68/75 veins (91%) remained electrically isolated; all PVs remained durably isolated in 79% of patients. Two patients accounted for 5 of 7 reconducting veins. The most common site for reconnection was the inferior aspect of the RIPV (3/7 reconnections). Reconnected veins had poorer occlusion at the index ablation procedure than veins that maintained chronic isolation (occlusion grade 2.9 ± 0.7 vs. 3.4 ± 0.7, P = 0.001). Clinical AF recurrence was detected in 2 patients (11%) at follow-up.
  
  
  CONCLUSIONS
  The improved thermodynamic characteristics of the second-generation cryoballoon led to a high rate of both single-shot PVI and chronic lesion durability. This high rate of durable PV isolation is anticipated to translate to improved clinical outcome.
authors: Cardiac Arrhythmia Service of the Mt. Sinai Hospital, New York, New York, USA.
authors: Vivek Y
authors: VY
authors: Reddy
authors: Homolka Hospital, Prague, Czech Republic.
authors: Lucie
authors: L
authors: Sediva
authors: Homolka Hospital, Prague, Czech Republic.
authors: Jan
authors: J
authors: Petru
authors: Homolka Hospital, Prague, Czech Republic.
authors: Jan
authors: J
authors: Skoda
authors: Homolka Hospital, Prague, Czech Republic.
authors: Milan
authors: M
authors: Chovanec
authors: Homolka Hospital, Prague, Czech Republic.
authors: Zita
authors: Z
authors: Chitovova
authors: EMEA Regional Clinical Center, Medtronic Clinical Research Institute, Milan, Italy.
authors: Paola
authors: P
authors: Di Stefano
authors: Medtronic Inc., Minneapolis, Minnesota, USA.
authors: Ethel
authors: E
authors: Rubin
authors: Cardiac Arrhythmia Service of the Mt. Sinai Hospital, New York, New York, USA.
authors: Srinivas
authors: S
authors: Dukkipati
authors: Homolka Hospital, Prague, Czech Republic.
authors: Petr
authors: P
authors: Neuzil
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation*; D018153:Czech Republic; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; cryoablation; cryoballoon; pulmonary vein isolation; recurrence