Background To prevent atrial fibrillation (AF) recurrence
after catheter ablation, pulmonary venous isolation (PVI)
at an antral level is more effective than segmental ostial
ablation. Cryoablation around the pulmonary venous (PV)
ostia for AF therapy is potentially safer compared to
radiofrequency ablation (RFA). The aim of this study was
to investigate the efficacy of a strategy using a large
cryoablation balloon to perform antral cryoablation with
‘touch-up’ ostial cryoablation for PVI in patients with
paroxysmal and persistent AF.
Methods Paroxysmal and persistent AF patients
undergoing their first left atrial ablation were recruited.
After cryoballoon therapy, each PV was assessed for
isolation and if necessary, treated with focal ostial
cryoablation until PVI was achieved. Follow-up with
Holter monitoring was performed. Clinical outcomes of
the cryoablation protocol were compared, with
consecutive patients undergoing PVI by RFA.
Results 124 consecutive patients underwent
cryoablation. 77% of paroxysmal and 48% of persistent
AF subjects were free from AF at 12 months after
a single procedure. Over the same time period, 53
consecutive paroxysmal AF subjects underwent PVI with
RFA and at 12 months, 72% were free from AF at
12 months (p¼NS). There were too few persistent AF
subjects (n¼8) undergoing solely PVI by RFA as
a comparison group. Procedural and fluoroscopic times
during cryoablation were significantly shorter than RFA.
Conclusions PV isolation can be achieved in less than
2 h by a simple cryoablation protocol with excellent
results after a single intervention, particularly for
paroxysmal AF.