title: Pulmonary vein isolation in patients with paroxysmal atrial fibrillation : Long-term clinical outcomes with first- and second-generation cryoballoons.
abstract: BACKGROUND
  The aim of this study was to evaluate the long-term success rates of pulmonary vein isolation (PVI) using only first-generation cryoballoon (CB-1) and second-generation CB (CB-2) in patients with paroxysmal atrial fibrillation (PAF).
  
  
  METHODS
  A total of 114 drug-refractory patients with PAF (mean age: 62 ± 10 years; 62.3 % males) were enrolled. All index ablation procedures were performed using a 28-mm CB. All patients were scheduled for outpatient clinic visits, followed by 24-h or 7‑day Holter electrocardiogram (EGC) evaluation.
  
  
  RESULTS
  All PVs in the CB-1 group and 367 of 368 (99.7 %) PVs in the CB-2 group were completely isolated during the index procedure. The most commonly observed complication was phrenic nerve palsy in four (4.3 %) patients with CB-2. The mean follow-up period for CB-1 and CB-2 was 33.4 ± 14.9 and 27.2 ± 10.6 months, respectively. Freedom from AF was 42.9 % for CB-1 and 74.2 % for CB-2 at the end of the follow-up period. The European Heart Rhythm Association score improved in patients without AF recurrence after the procedure (2.8 ± 0.4 vs. 1.2 ± 0.5, p < 0.001), whereas no significant improvement was observed in the symptomatic status of patients with recurrence (2.8 ± 0.4 vs. 2.2 ± 0.9, p = 0.149).
  
  
  CONCLUSIONS
  Second-generation CB provided significantly better clinical outcomes than its predecessor and was associated with low peri- and postprocedural complications.
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany. b.koektuerk@khporz.de.
authors.forename: B
authors.initials: B
authors.lastname: Koektuerk
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Yorgun
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: C H
authors.initials: CH
authors.lastname: Turan
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Keskin
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Dahmen
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hoppe
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Gorr
authors.affiliation: Department of Radiology, Krankenhaus Porz Am Rhein, Cologne, Germany.
authors.forename: P M
authors.initials: PM
authors.lastname: Bansmann
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: R G
authors.initials: RG
authors.lastname: Turan
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Horlitz
authors.affiliation: Department of Cardiology/Electrophysiology, Witten/Herdecke University, Krankenhaus Porz am Rhein, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Yang
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012133:Respiratory Paralysis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Atrial fibrillation, paroxysmal; Balloon ablation; Follow-up, long-term; Pulmonary vein; Second-generation cryoballoon