title: The Impact of Left Atrial Surface Area and the Second Generation Cryoballoon on Clinical Outcome of Atrial Fibrillation Cryoablation.
abstract: OBJECTIVE
  In this observational study, we examine the significance of the left atrial (LA) surface area and compare the clinical usage of the Arctic Front Advance (CBA) versus Arctic Front (CB) cryoballoon with the intent to investigate the impact of each in terms of long-term freedom from atrial fibrillation (AF) for patients with nonvalvular AF.
  
  
  METHODS
  Pulmonary vein isolation (PVI) was performed while using a cryoballoon ablation catheter in conjunction with an intraluminal circular diagnostic mapping catheter, Achieve. The consecutive patients ablated with CBA were matched with patients previously ablated with CB, using propensity score matching. The primary endpoint of this observational single-center retrospective study was the first observation of electrocardiogram-documented recurrence of atrial arrhythmias lasting >30 seconds.
  
  
  RESULTS
  The patient demographic data were similar in the CBA- and CB-group (N = 188 patients each group). In all patients in the CBA-group and in 95% of the patients in the CB group, acute procedural PVI of all veins was achieved with the single usage of a 28-mm cryoballoon. The one-year freedom from atrial arrhythmias was significantly better in the CBA- versus the CB-group of patients, 90% versus 64%, respectively. During 15-month clinical follow-up in CBA group, patients with LA area above 23 cm(2) were more likely to experience recurrence of AF (23%) than patients with LA area below 23 cm(2) (7%).
  
  
  CONCLUSIONS
  Comparing one-year outcomes, the CBA is superior to the CB with regards to maintenance of normal sinus rhythm. When using the CBA catheter, an enlarged LA is associated with a higher recurrence of arrhythmia.
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Harald
authors: H
authors: Greiss
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Alexander
authors: A
authors: Berkowitsch
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Maciej
authors: M
authors: Wojcik
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Sergej
authors: S
authors: Zaltsberg
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Dimitri
authors: D
authors: Pajitnev
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Nikolas
authors: N
authors: Deubner
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Ersan
authors: E
authors: Akkaya
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Norbert
authors: N
authors: Güttler
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.|Medizinische Klinik I, Justus-Liebig University, Giessen, Germany.
authors: Christian
authors: C
authors: Hamm
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Thomas
authors: T
authors: Neumann
authors: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors: Malte
authors: M
authors: Kuniss
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D004452:Echocardiography; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: ablation; arrhythmia; catheter ablation; cryoballoon; long-term follow-up; paroxysmal atrial fibrillation; pulmonary vein isolation; tachyarrhythmias