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Second-Generation Cryoballoon versus RF. Introduction:There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies.Methods and Results: In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and openirrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001).Conclusion: In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone. (J Cardiovasc Electrophysiol, Vol. 26, pp. 832-839, August 2015) atrial fibrillation, catheter ablation, cryoablation, cryoballoon, phrenic nerve palsy Drs. Aryana, Kowalski, Banker, and O'Neill have received consulting fees and speaker honoraria, and Drs. Aryana and O'Neill have received a research grant from Medtronic, Inc., the manufacturer of the second-generation cryoballoon used in this study. Additionally, Drs. Cohen, Banker, Fuenzalida, and d'Avila have received consulting fees and speaker honoraria, and Drs. Aryana and O'Neill have received research grants from Biosense Webster, Inc., the manufacturer of the radiofrequency ablation catheter used in this study. Other authors: No disclosures.

Hemangiomas of the mediastinum are rare tumors. Fewer than 100 have been reported. This study reviews the cases of 15 patients with mediastinal hemangiomas confirmed pathologically. We analyzed and evaluated the presentation, evaluation, and treatment. Follow-up is available for 14 of the 15 patients and ranges from 15 months to 15 years. Eight of the 15 patients were seen with signs and symptoms related to the tumor. This presentation correlated with invasion of contiguous mediastinal structures by the tumor. Six patients underwent total excision and 6, subtotal excision. During follow-up, residual tumor did not spread, become symptomatic, or show evidence of malignant degeneration. Based on this analysis, we believe that in patients in whom total excision of this tumor can be accomplished only by hazardous resection, a subtotal resection should be performed.

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A pedicled left internal thoracic artery graft to the left anterior descending artery reduces blood flow to the left side of the sternum during the acute postoperative period. This does not occur when the left internal thoracic artery is skeletonized.

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