title: One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis.
abstract: OBJECTIVE
  The purpose of this study was to determine efficacy of pulmonary vein isolation (PVI) using the 28 mm cryoballoon (CB) in patients with persistent atrial fibrillation (AF). Superior acute and 1-year outcome has been demonstrated following PVI, using the second-generation CB in patients with paroxysmal AF. Data on the outcome in patients with persistent AF are sparse.
  
  
  RESULTS
  Forty-nine patients (20 female, mean age 63 ± 10 years, mean left atrial diameter 46 ± 5 mm) with persistent AF [median AF duration since first diagnosis: 48 (20:192) months] underwent second-generation 28 mm CB-based PVI. The freeze cycle duration was set at 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 11/49 (22%) patients, and no bonus freeze cycle was used in the remaining 38/49 (78%) patients. Follow-up (FU) was based on outpatient clinic visits at 3, 6, and 12 months, which included Holter electrocardiograms and telephone interviews. Recurrence was defined as an episode of symptomatic and/or documented atrial tachyarrhythmia >30 s beyond the 3-month blanking period. A total of 193 pulmonary veins (PVs) were identified and 193/193 (100%) PVs were successfully isolated. No phrenic nerve paralysis occurred. Follow-up was obtained in 49/49 (100%) patients with a mean FU duration of 416 ± 178 days. After the 3-month blanking period, antiarrhythmic medication was discontinued in 33/49 (67%) patients. Thirty-four of 49 (69%) patients remained in stable sinus rhythm.
  
  
  CONCLUSIONS
  In patients with persistent AF, use of the second-generation 28 mm CB was associated with a 69% 1-year clinical success rate.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany c.lemes@asklepios.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Lemes
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Deiss
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Heeger
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Reissmann
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Tilz
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg 20099, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation*; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D004867:Equipment Design; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Cryoballoon; Long-term follow-up; Persistent atrial fibrillation; Pulmonary vein isolation