Pulmonary vein isolation as an index procedure for persistent atrial fibrillation: One-year clinical outcome after ablation using the second-generation cryoba Q3 lloon Giuseppe Cicon Q4 te, MD, * Luca Ottaviano, MD, † Carlo de Asmundis, MD, PhD, * Giannis Baltogiannis, MD, * Giulio Conte, MD, * Juan Sieira, MD, * Giacomo Di Giovanni, MD, * Yukio Saitoh, MD, * Ghazala Irfan, MD, * Giacomo Mugnai, MD, * Cesare Storti, MD, ‡ Annibale Sandro Montenero, MD, PhD, † Gian-Battista Chierchia, MD, PhD, * Pedro Brugada, MD, PhD * Q1 From the * Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium, † Cardiovascular Department, IRCCS Multimedica, Sesto S. Giovanni, Milan, Italy, and ‡ Electrophisiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy. BACKGROUND No data are available about the clinical outcome of pulmonary vein isolation (PVI) as an index procedure for persistent atrial fibrillation (PersAF) ablation using the second-generation cryoballoon (CB-Adv). OBJECTIVE The purpose of this study was to assess the 1-year efficacy of PVI as an index procedure for PersAF ablation using the novel CB-Adv. METHODS Sixty-three consecutive patients (45 male [71.4%], mean age 62.7  9.7 years) with drug-refractory PersAF undergoing PVI using the novel CB-Adv were enrolled. Follow-up was based on outpatient clinic visits including Holter ECGs. Recurrence of atrial tachyarrhythmias (ATs) was defined as a symptomatic or docu- mented episode 430 seconds. RESULTS A total of 247 PVs were identified and successfully isolated with a mean of 1.7  0.4 freezes. Mean procedural and fluoroscopy times were 87.1  38.2 minutes and 14.9  6.1 minutes, respectively. Among 26 of 63 patients (41.3%) presenting with AF at the beginning of the procedure, 7 of 26 (26.9%) converted to sinus rhythm during ablation. Phrenic nerve palsy occurred in 4 of 63 patients (6.3%). At 1-year follow-up, after a 3-month blanking period (BP), 38 of 63 patients (60.3%) were in sinus rhythm. Because of AT recurrences, 9 patients underwent a second procedure with radiofrequency ablation showing a pulmo- nary vein reconnection in 4 right-sided PVs (44.4%) and 3 left- sided PVs (33.3%). Multivariate analysis demonstrated that PersAF duration (P ¼ .01) and relapses during BP (P ¼ .04) were independent predictors of AT recurrences. CONCLUSION At 1-year follow-up, freedom from ATs following PersAF ablation with the novel CB-Adv is 60%. Phrenic nerve palsy is the most common complication. PersAF duration and relapses during the BP appear to be significant predictors of arrhythmic recurrences. KEYWORDS Cryoballoon ablation; Second-generation cryoballoon; Persistent atrial fibrillation; Pulmonary vein isolation; One-year follow-up ABBREVIATIONS AAD ¼ antiarrhythmic drug; AF ¼ atrial fibrillation; AT ¼ atrial tachyarrhythmia; LA ¼ left atrium; PersAF ¼ persistent atrial fibrillation; PV ¼ pulmonary vein; PVI ¼ pulmonary vein isolation; SR ¼ sinus rhythm (Heart Rhythm 2014;0:0–7) I 2014 Heart Rhythm Society. All rights reserved. Introduction The second-generation cryoballoon (CB-Adv; Arctic Q5 Front Advance, Medtronic Inc, Minneapolis, MN) is a safe and effective ablation device for pulmonary vein isolation (PVI). 1–4 Compared to the first generation, the CB-Adv has been designed with technical developments resulting in a larger and more homogeneous zone of freezing on its surface, which translates into significant improvements in procedural and clinical outcomes. 3,4 Recently, acute and mid-term follow-up studies demon- strated the efficacy of this procedure, reporting a clinical success rate of approximately 80% in patients with paroxysmal and short-standing persistent atrial fibrillation (PersAF). 3–6 To date, however, only sparse data are available about efficacy and 1-year clinical outcome after PVI for PersAF ablation using the cryoballoon. To the best of our knowledge, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 Drs. Chierchia and Brugada contributed equally to this article as senior author. Drs. Chierchia and de Asmundis receive compensation for teaching and proctoring purposes from AF Solutions Medtronic. Address reprint requests and correspondence: Dr. Giuseppe Ciconte, Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium. E-mail address: g.ciconte@gmail.com. 1547-5271/$-see front matter B 2014 Heart Rhythm Society. All rights reserved. http://dx.doi.org/10.1016/j.hrthm.2014.09.063