A novel double cryoballoon strategy in persistent atrial fibrillation: a pilot study

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Cryoballoon ablation shows promise for paroxysmal atrial fibrillation (AF).
• Success rates for persistent AF using cryoballoon technology have been limited.
• A need exists for more extensive ablation strategies, termed 'pulmonary vein isolation plus.'

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of a novel 'double balloon strategy' for persistent AF.
• To combine ostial pulmonary vein isolation (PVI) with antral substrate modification using both 23-mm and 28-mm cryoballoons in a single procedure.

Main Methods:

• Prospective study of 33 consecutive patients with persistent AF.
• The 'double balloon strategy' involved at least two 23-mm cryoballoon applications for ostial PVI and at least one 28-mm cryoballoon application for antral modification per pulmonary vein.
• Follow-up included 7-day Holter monitoring at regular intervals up to 24 months post-ablation.

Main Results:

• 131 of 133 targeted pulmonary veins (98.4%) were successfully isolated.
• A mean of 14 applications per patient (3.5 per vein) were performed.
• After a mean follow-up of 15 months, 69.7% of patients remained in sinus rhythm, with no major complications.

Conclusions:

• The 'double balloon strategy' is a feasible and safe approach for persistent AF.
• Combining ostial PVI with antral cryoablation using sequential small and large cryoballoons yields favorable outcomes.
• This technique represents a promising advancement in the treatment of persistent atrial fibrillation.