AimsCryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, Cryocath™) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether ‘single big cryoballoon’-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).Methods and resultsAfter double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA–PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 ± 9 years, LA size: 42 ± 5 mm) with PAF (mean duration: 6.6 ± 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q1; Q3) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q1; Q3) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).ConclusionUsing the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

For the first time, it was demonstrated that high ablation power affects acute and chronic outcomes. High-dose laser balloon ablation allows for an acute PVI rate of 89% solely by visually guided circular ablation and is associated with a chronic success rate of 83% after a single procedure.

Pulmonary vein (PV) isolation for ablation of atrial fibrillation is a well-accepted therapy option for high symptomatic patients refractory to antiarrhythmic drugs. Radiofrequency point-by-point ablation is the gold-standard technique; however, in the last two decades, many new technologies have been developed. The endoscopic ablation system makes direct PV ostium visualization possible, despite the large anatomy variation thanks to its compliant balloon. The laser generator delivers precise lesions that in the first clinical studies seem to be durable, with a safety and efficacy profile similar to the other PV isolation techniques. If these early results are confirmed by larger clinical studies, the endoscopic ablation system will offer a new paradigm in ablation of cardiac arrhythmias by directly visualizing the target substrate.

We present a technically challenging case of pulmonary vein isolation (PVI) after complete left-sided pneumonectomy, resulting in uncommon cardiac rotation. Wide area circumferential PVI after pneumonectomy is technically challenging but feasible in experienced centres. Correct identification of the PV ostia is crucial before ablation.

No abstract

No abstract

Background: A novel multielectrode radiofrequency balloon (RFB) catheter has been released for pulmonary vein isolation (PVI). Methods and Results:In this observational study consecutive patients with drug-refractory paroxysmal or persistent atrial fibrillation (AF) undergoing first-time PVI were enrolled in 2 high-volume ablation centers. All procedures were conducted in conjunction with a 3D-mapping system. Clinical, procedural and ablation parameters were systematically analyzed. 105 patients (58% male; 52% paroxysmal AF, 68±11.3 years mean age, left atrial volume index 38.6±14.8 mL/m 2 ) were included. 241/412 (58.5%) PVs were successfully isolated with a single shot (SS), with a time-to-isolation of 11.6±8 s. Total number of radiofrequency applications was 892 (mean 2.2/PV), resulting in successful isolation of 408/412 (99%) PVs at the end of the procedure. Mean electrodes' impedance drop was significantly higher in the SS-PVI compared with non-SS applications (21.5±6.6 vs. 18.6±6.5 Ohm). Concordantly, higher temperature rise was observed in the SS vs. non-SS applications (10.9±4.9°C vs. 9.6±4.7°C). Conclusions:In this multicenter real-world study, mean impedance drop and temperature rise were associated with successful SS-PVI applying the novel RFB catheter. These parameters may help to guide efficient usage of the new RF balloon.