title: Cryoballoon ablation for persistent atrial fibrillation - Large single-center experience.
abstract: Different catheter ablation (CA) strategies have been established in the treatment of persistent atrial fibrillation (persAF). Pulmonary vein isolation (PVI) only might be an option for the initial ablation procedure. There is a paucity of outcome data on second-generation cryoballoon (CBG2) PVI in persAF.
  
  
  
  Patients with symptomatic drug-refractory persAF who underwent initial CA of AF were prospectively enrolled and PVI was performed with CBG2. The primary composite endpoint was freedom from AF, atrial tachycardia, or related symptoms after a 3-month blanking period. The secondary endpoint referred to periprocedural complications.
  
  
  
  One hundred seventy-three consecutive patients (64±10 years, 29% female) with symptomatic drug-refractory persAF were identified. Acute PVI was achieved in 100% of pulmonary veins with the CB technique. The left atrial procedure time was 112±30min. Major complications occurred in 1.7% (3 of 173 patients) including two phrenic nerve palsies (1%), which resolved until discharge, and one pericardial effusion (0.6%). Follow-up ≥12 months was completed for 157 of 173 patients (91%). Median follow-up was 14 months. At 12 months, the primary composite endpoint was achieved in 129 of 157 patients (82%). However, 22 of 129 patients at risk (17%) were still on antiarrhythmic drugs. A relapse during the blanking period was identified as the only independent predictor for AF recurrence.
  
  
  
  PVI using the second-generation cryoballoon is a reasonable treatment option for patients with symptomatic drug-refractory persAF with a favorable rate of freedom from AF and a low complication rate.
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany. Electronic address: florian.straube@klinikum-muenchen.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Straube
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hartl
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Dorwarth
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wankerl
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Bunz
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Ablation; Atrial fibrillation; Cryoballoon; Persistent atrial fibrillation; Pulmonary vein isolation