Aims: Cryoballoon technology is a promising technique in paroxysmal atrial fibrillation (AF) ablation. However, success rates in patients with persistent AF have not been convincing. There is a trend toward performing more extensive procedures that are referred to as 'pulmonary vein isolation plus.' To combine pulmonary vein isolation (PVI) and antral substrate modification, we used both the 23-mm and 28-mm cryoballoon in a single approach in patients with persistent AF.
Methods and results: 33 consecutive patients (26 men, age 60 ± 10 years, LA size 44 ± 5 mm) with persistent AF were prospectively included. All patients underwent the "double balloon strategy:" at least two applications at each pulmonary vein (PV) using the smaller 23-mm balloon to isolate the PV at the ostial level plus at least one additional freeze by the 28-mm balloon at the wide PV antral level. 7-day Holter monitors were performed during follow-up at 1, 3, 6, 9, 12, 18 and 24 months post-ablation. 131 of 133 PVs were targeted and isolated (98.4 %). A mean of 14 ± 2 cryoballoon applications per patient or 3.5 ± 1.5 applications per vein were performed. After a single procedure and mean follow-up of 15 ± 3 months, 69.7 % of patients remained in sinus rhythm (3-month blanking period). There were no major complications.
Conclusions: In persistent AF, the "double balloon strategy;" combining the small and large cryoballoon allowed ostial PV isolation followed by antral cryoablation is feasible, safe and associated with a favorable outcome.