Earliest pulmonary vein potential-guided cryoballoon ablation for atrial fibrillation

Abstract

No studies have evaluated both the time-to-isolation (TTI) and the sequence of pulmonary vein (PV) potentials in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study aimed to prospectively evaluate the acute results of pulmonary vein isolation (PVI) using a novel CBA technique—the earliest potential (EP) of PV-guided CBA—in paroxysmal AF. We pressed a balloon against the earliest PV potential site during PVI when TTI could not be achieved within 60\xa0s (EP-guided CBA group). We compared 32 patients consecutively treated by EP-guided CBA to 32 patients treated without pressing the balloon against the EP site (conventional CBA group). The cryoapplication protocol was the same, except with regard to the pressing of the balloon. All 256 PVs (EP-guided CBA group, 128 PVs; conventional CBA group, 128 PVs) were isolated successfully. The TTI observation rate was similar in both groups. Compared with conventional CBA, EP-guided CBA was associated with a lower non-success rate of TTI\u2009≤\u200990\xa0s (9% vs. 26%; P \u2009=\u20090.040) and shorter left atrial dwell time (38\u2009±\u20099 vs. 46\u2009±\u200919\xa0min; P \u2009=\u20090.036), total procedure time (76\u2009±\u200915 vs. 87\u2009±\u200923\xa0min; P \u2009=\u20090.043), and fluoroscopy time (23\u2009±\u20098 vs. 30\u2009±\u200911\xa0min; P \u2009=\u20090.006). This novel EP-guided CBA approach may help facilitate the ablation procedure.