Safety and efficacy outcomes in patients undergoing pulmonary vein isolation with second-generation cryoballoon

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Abstract
The second-generation cryoballoon (Arctic Front Advance™) (Arc-Adv-CB) has a redesigned injection system which distributes the refrigerant homogenously to the frontal balloon surface. The aim of this study was to compare the efficacy and safety of the Arc-Adv-CB and its predecessor (Arctic Front™) (Arc-CB) in patients who underwent pulmonary vein isolation (PVI) for atrial fibrillation (AF). Three hundred and six patients (55.35 ± 10.60 years, 47.05% male) were included in the study. A total of 1205 pulmonary veins were attempted for PVI with either Arc-CB or Arc-Adv-CB. The follow-up durations were 30 (23–38) and 10 (8–13) months in Arc-CB and Arc-Adv-CB groups, respectively (P < 0.001). When the blanking period was considered, freedom from AF after a single ablation procedure was 68.53 and 90.83% in patients undergoing PVI with Arc-CB and Arc-Adv-CB, respectively. The most frequent complication was transient phrenic nerve palsy (PNP) which occurred in five(2.54%) and nine(8.26%) of patients undergoing PVI with Arc-CB and Arc-Adv-CB, respectively (P = 0.040). Left atrial (LA) diameter (hazard ratio, HR: 3.552, 95% CI: 2.034–6.201, P < 0.001), smoking history (HR:1.643, 95% CI: 1.011–2.671, P = 0.045), persistent AF (HR:1.725, 95% CI: 1.021–2.915, P = 0.041), duration of AF (HR:1.039, 95% CI: 1.000–1.080, P = 0.047), and early AF recurrence (HR:2.399, 95% CI: 1.443–3.989, P < 0.001) were associated with increased late AF recurrence. On the other hand, intraprocedural vagal reactions (HR: 0.550, 95% CI: 0.331–0.915, P = 0.021) and Arc-Adv-CB use (HR: 0.441, 95% CI: 0.225–0.866, P = 0.017) were associated with lower late AF recurrence. Left atrial diameter (HR: 3.072, 95% CI: 1.646–5.732, P < 0.001), early AF recurrence (HR: 1.906, 95% CI: 1.103–3.291, P = 0.021), and Arc-Adv-CB use (HR: 0.472, 95% CI: 0.239–0.931, P = 0.030) were independent predictors for late AF recurrence. Our study has shown that Arc-Adv-CB use is associated with lower late AF recurrences at the cost of an increased risk for PNP.

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