title: Improved visualisation of real-time recordings during third generation cryoballoon ablation: a comparison between the novel short-tip and the second generation device.
abstract: BACKGROUND
  The third-generation Cryoballoon Advance Short-tip (CB-ST) has been designed with a 40 % shortened tip length compared with the former second generation CB advance device (CB-A). Ideally, a shorter tip should permit an improved visualisation of real-time recordings in the pulmonary vein (PV) due to a more proximal positioning of the inner lumen mapping catheter. We sought to compare the incidence of visualisation of real-time recordings in patients having undergone ablation with the CB-ST with patients having received CB-A ablation.
  
  
  METHODS
  All patients having undergone CB ablation using CB-ST technology and the last 500 consecutive patients having undergone CB-A ablation were analysed. Exclusion criteria were the presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease, and contraindications to general anaesthesia.
  
  
  RESULTS
  A total of 600 consecutive patients (58.1 ± 12.9 years, 64 % males) were evaluated (100 CB-ST and 500 CB-A ablations). Real-time recordings were significantly more prevalent in the CB-ST population compared with CB-A group (85.7 vs 67.2 %, p < 0.0001). Real-time recordings could be more frequently visualised in the CB-ST group in all types of veins (LSPV 89 vs 73.4 %, p = 0.0005; LIPV 84 vs 65.6 %, p = 0.0002; RSPV 87 vs 67.4 %, p < 0.0001; RIPV 83 vs 62.4 %, p < 0.0001).
  
  
  CONCLUSIONS
  The rate of visualisation of real-time recordings is significantly higher during third-generation CB-ST ablation if compared to the second-generation CB-A device. Real-time recordings can be visualised in approximately 85.7 % of veins with this novel cryoballoon.
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium. mugnai.giacomo@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Burak
authors.initials: B
authors.lastname: Hünük
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ströker
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Darragh
authors.initials: D
authors.lastname: Moran
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Ebru
authors.initials: E
authors.lastname: Hacioglu
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Diego
authors.initials: D
authors.lastname: Ruggiero
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Poelaert
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Christian
authors.initials: C
authors.lastname: Verborgh
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Umbrain
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Beckers
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Hugo Enrique
authors.initials: HE
authors.lastname: Coutino-Moreno
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Ken
authors.initials: K
authors.lastname: Takarada
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Valentina
authors.initials: V
authors.lastname: de Regibus
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000379:methods; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D003199:Computer Systems; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Atrial fibrillation; Catheter ablation; Cryoballoon; Pulmonary vein isolation; Short tip