Advancing the Achieve Catheter in Different Branches of Pulmonary Vein as a Routine Approach During Cryoballoon...

Cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) has demonstrated high procedural success rate and promising clinical outcome. How to expand the antrum ablation area and get better results is a challenging topic for patients with paroxysmal and persistent AF.

We enrolled 709 patients with nonvalvular AF who underwent initial PVI with a second-generation CB between January 2020 and August 2022, including 293 CBA applications in different branches of each PV and 416 in the same branch of each PV. The orientation difference in the transverse plane was negatively correlated with the ostium-bifurcation distance. In the different-branch CBA group, after the first application in one branch, PV potentials could still be recorded in the other branch in 39 of the 293 patients (13.3%) and the PV foci could trigger AF in 7 of them. In a consecutive 30 patients by using 3D mapping system, the total antral surface lesions after the application in a second branch were larger than those after the first application (p < 0.001). The fluoroscopy time increased in the different-branch CBA group. The recurrence rate of atrial arrhythmia was statistically lower in the different-branch CBA group compared with that in the same-branch CBA group (p = 0.034) at a 2-year follow-up.

CBA applications performed in different branches of each PV could create wide isolated antral surface areas and eliminate PV foci adequately. CBA in different branches of PVs with long ostium-bifurcation distances had less significance. The recurrence rate of atrial arrhythmia was statistically lower in the different-branch CBA group compared with that in the same-branch CBA group.