title: Second-generation cryoballoon ablation without the use of real-time recordings: A novel strategy based on a temperature-guided approach to ablation.
abstract: The achievement of -40°C within the first 60 seconds during cryoenergy applications has proven to independently predict durable pulmonary vein (PV) isolation in the setting of second-generation cryoballoon (CB-A; Medtronic, Minneapolis, MN) ablation.
  
  
  
  We sought to evaluate a strategy based on the attainment of the specific parameter of -40°C within the first 60 seconds during cryoenergy applications in the setting of CB-A ablation without the use of an inner lumen mapping catheter (Achieve, Medtronic) for the visualization of real-time recordings.
  
  
  
  A total of 52 patients having undergone CB ablation for paroxysmal atrial fibrillation (AF) between 1 February 2015 and 30 June 2015 who underwent a temperature-guided approach based on achieving -40°C within 60 seconds without real-time recordings (wire group) were compared with a cohort of 52 propensity score-matched patients having undergone CB ablation performed with an inner lumen mapping catheter (Achieve group). All PVs were checked for electrical isolation at the end of the procedure with a circular mapping catheter in the wire group.
  
  
  
  Electrical isolation could be obtained in all patients in the Achieve group and in 99% of PVs in the wire group. Freedom from AF without antiarrhythmic drugs at a mean follow-up of 12.4 ± 3.0 months did not significantly differ between both groups (85% vs 88%, respectively; P = .56).
  
  
  
  A temperature-guided approach based on achieving -40°C within 60 seconds is effective in producing PV isolation and affords freedom from AF at 12-month follow-up in 85% of patients affected by paroxysmal AF after a 3-month blanking period.
authors.affiliation: Electrophysiology Unit, Maria Cecilia Hospital, Gruppo Villa Maria, Cotignola, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Iacopino
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Ken
authors.initials: K
authors.lastname: Takarada
authors.affiliation: Electrophysiology Unit, Cliniques de l'Europe, Brussels, Belgium.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paparella
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ströker
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Valentina
authors.initials: V
authors.lastname: De Regibus
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Hugo Enrique
authors.initials: HE
authors.lastname: Coutino-Moreno
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Rajin
authors.initials: R
authors.lastname: Choudhury
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Abugattas de Torres
authors.affiliation: Electrophysiology Unit, Maria Cecilia Hospital, Gruppo Villa Maria, Cotignola, Italy; Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Electrophysiology Unit, Maria Cecilia Hospital, Gruppo Villa Maria, Cotignola, Italy; Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Electrophysiology Unit, Maria Cecilia Hospital, Gruppo Villa Maria, Cotignola, Italy; Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium. Electronic address: gbchier@yahoo.it.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000601:surgery*; D001530:Belgium; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods; D003080:Cold Temperature; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods; D004351:Drug Resistance; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011667:Pulmonary Veins / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Cryoballoon ablation; Paroxysmal atrial fibrillation; Pulmonary vein isolation; Real-time recording; Temperature-guided approach