231 Circumferential pulmonary vein isolation with a cryoballoon: safety, efficacy and follow-up (experience of the rythmology Unit, CHU Grenoble)

Pulmonary vein isolation (PVI) became the usual approach for the treatment of atrial fibrillation (AF) refractory to medical antiarrhythmic treatment. Pulmonary vein isolation with a cryoballoon is a new technique wich allows a circumferential PVI. Aim to assess the feasibility, efficacy, and safety of using a cryoballoon catheter to achieve pulmonary vein isolation (PVI). Methods 67 patients with symptomatic AF (50 paroxysmal) were accepted for PVI with a cryoballoon. They were seen on an outpatient basis every three months or if they complained of AF-related symptoms. A 48-hour Holter recording was used to document asymptomatic AF at 3 months. We compiled acute and mid-term results and reviewed complications and safety issues with regard to the procedure. Results 217 (85%) veins were successfully isolated with a single cryoballoon application. The success of isolation depends on the extent of venous occlusion during application. The average procedure time was 178 minutes; the average fluoroscopy time, 43 minutes. Patients were followed for a median of 9.7 months. Eighty-five percent were free from recurrent AF or arrhythmia-related symptoms. Freedom from AF results were more significant among patients with paroxysmal AF (90% of patients Vs 60% among patients with persistent AF). The phrenic nerve palsy (PNP) is the most frequent complication (6 cases), it is always reversible. Four patients have presented a minor pericardic effusion. Conclusions despite the occurrence of minor complications, PVI using a cryoballoon is feasible with a high rate of acute success and excellent mid-term results. These results, comparable to those obtained with radiofrequency (RF) energy, have helped make cryoballoon ablation our first-line therapy for the treatment of paroxysmal AF.