title: Outcomes after cryoablation vs. radiofrequency in patients with paroxysmal atrial fibrillation: impact of pulmonary veins anatomy.
abstract: OBJECTIVE
  Pulmonary vein isolation is the mainstay of treatment in catheter ablation of paroxysmal atrial fibrillation (AF). Cryoballoon ablation has been introduced more recently than radiofrequency ablation, the standard technique in most centres. Pulmonary veins frequently display anatomical variants, which may compromise the results of cryoballoon ablation. We aimed to evaluate the mid-term outcomes of cryoballoon ablation in an unselected population with paroxysmal AF from an anatomical viewpoint.
  
  
  RESULTS
  Consecutive patients with paroxysmal AF who underwent a first procedure of cryoballoon ablation or radiofrequency were enrolled in this single-centre study. All patients underwent systematic standardized follow-up. Comparisons between radiofrequency and cryoballoon ablation (Arctic Front™ or Arctic Front Advance™) were performed regarding safety and efficacy endpoints, according to pulmonary vein (PV) anatomical variants. A total of 687 patients were enrolled (376 radiofrequency and 311 cryoballoon ablation). Baseline characteristics and distribution of PV anatomical variants were generally similar in the groups. After a mean follow-up of 14 ± 8 months, there was no difference in the incidence of relapse (17.0% cryoballoon ablation vs. 14.1% radiofrequency, P = 0.25). We observed no interaction of PV anatomical variants on mid-term procedural success.
  
  
  CONCLUSIONS
  Our findings suggest that mid-term outcomes of cryoballoon ablation for paroxysmal AF ablation are similar to those of radiofrequency, regardless of PV anatomy. The presence of anatomical variants of PVs should not discourage the referral of patients with paroxysmal AF for cryoballoon ablation.
authors.affiliation: INSERM U1046, Université Montpellier1, Université Montpellier 2, Montpellier, France CHRU Montpellier, Service de Cardiologie, Montpellier 34090, France ziad.khoueiry@gmail.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Khoueiry
authors.affiliation: Départment de Rhythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Albenque
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Providencia
authors.affiliation: Départment de Rhythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Combes
authors.affiliation: Départment de Rhythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Combes
authors.affiliation: Department of Cardiology, Auxerre Hospital, Auxerre, France.
authors.forename: F
authors.initials: F
authors.lastname: Jourda
authors.affiliation: Départment de Rhythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: P A
authors.initials: PA
authors.lastname: Sousa
authors.affiliation: Department of Cardiology, University Hospital Rangueil, Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Cardin
authors.affiliation: INSERM U1046, Université Montpellier1, Université Montpellier 2, Montpellier, France CHRU Montpellier, Service de Cardiologie, Montpellier 34090, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Pasquie
authors.affiliation: INSERM U1046, Université Montpellier1, Université Montpellier 2, Montpellier, France CHRU Montpellier, Service de Cardiologie, Montpellier 34090, France.
authors.forename: T T
authors.initials: TT
authors.lastname: Cung
authors.affiliation: INSERM U1046, Université Montpellier1, Université Montpellier 2, Montpellier, France CHRU Montpellier, Service de Cardiologie, Montpellier 34090, France.
authors.forename: F
authors.initials: F
authors.lastname: Massin
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre (PARCC), Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Départment de Rhythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Boveda
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D003452:Cryosurgery / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cryoballoon ablation; Paroxysmal atrial fibrillation; Pulmonary vein anatomy; Radiofrequency ablation