Optimizing cryoballoon pulmonary vein isolation: lessons from >1000 procedures— the Frankfurt approach

Abstract Aims Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety a high volume centre with long experience the use of second-generation CB (CB2). Methods results Consecutive paroxysmal AF (PAF) or persistent (persAF) patients undergoing CB2-PVI were enrolled. Procedural data, efficacy, issues systematically collected. The 28 mm CB2 was used combination inner lumen spiral catheter, luminal oesophageal temperature (LET) probe cut-off 15°C, phrenic nerve (PN) monitored during septal PVs ablation. Freeze duration mainly set at 240 s bonus application case delayed time-to-isolation (TTI > 75 s). A total 1017 procedures analysed (58% male, 66 ± 12 years old, 70% PAF). 3964 identified, 99.8% isolated using solely CB. Mean procedure time 69 25 min, TTI first recorded 77% after mean 48 31 s. 0.2% cardiac tamponade, 4.8% PN injury (1.6% palsy), 19% LET < 15°C. Among 725 follow-up 84% PAF 75% persAF stable SR 1 year. Shorter freezing longer procedural predictors recurrence. Conclusion are fast associated benign profile. freeze durations sinus follow-up.