title: Outcomes following cryoballoon ablation for atrial fibrillation guided by pressure waveform monitoring without the routine use of pulmonary venography.
abstract: OBJECTIVE
  Pressure waveform analysis has the potential for facilitated assessment of pulmonary vein occlusion during cryoballoon ablation for atrial fibrillation. Data on clinical outcomes using this method are lacking. We sought to validate through clinical outcomes the use of pressure waveform analysis as the primary method of determining pulmonary vein occlusion during cryoballoon ablation.
  
  
  METHODS
  A study was performed of 122 consecutive patients with atrial fibrillation (85% paroxysmal) undergoing cryoballoon ablation from May 2014 through July 2015 at a single institution using pressure waveform analysis as the primary method of assessing pulmonary vein occlusion.
  
  
  RESULTS
  Cryoballoon ablation, with additional segmental radiofrequency ablation in 13.7%, resulted in complete pulmonary vein isolation in 100% of patients. The single procedure freedom from recurrence of atrial arrhythmia beyond the initial 3-month post-ablation was 81.2% at a mean follow-up of 237 days. Recurrence of atrial arrhythmia within 3-month post-ablation was 11.1%, and predicted recurrence beyond 3 months. Repeat ablation was performed in 12.0% of patients.
  
  
  CONCLUSIONS
  In the largest study to date on this topic and the only study to focus on clinical outcomes, pressure waveform analysis as the primary method of determining pulmonary vein occlusion in cryoballoon ablation of atrial fibrillation resulted in acute and long-term procedural success rates comparable to those reported with use of routine pulmonary venography. Controlled study is needed to confirm these findings and to determine if this technique affects variables such as procedure duration and radiation exposure.
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.
authors.forename: Akshit
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.
authors.forename: Jashdeep
authors.initials: J
authors.lastname: Dhoot
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.|Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.|Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.|Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Medicine, School of Medicine, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA. awimmer@saint-lukes.org.|Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA. awimmer@saint-lukes.org.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Wimmer
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D001795:Blood Pressure Determination / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010690:Phlebography / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cryoballoon ablation; Pressure waveform analysis; Pulmonary vein isolation; Second-generation cryoballoon