The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study

Eur Heart J. 2009 Mar;30(6):699-709. doi: 10.1093/eurheartj/ehn570. Epub 2008 Dec 24.


Aims: Cryothermal 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 results: After 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 (Q(1); Q(3)) 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 (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).

Conclusion: Using 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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon / instrumentation
  • Angioplasty, Balloon / methods*
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / instrumentation
  • Catheter Ablation / methods*
  • Coronary Angiography
  • Cryosurgery / instrumentation
  • Cryosurgery / methods*
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / surgery
  • Humans
  • Male
  • Middle Aged
  • Phrenic Nerve / physiopathology
  • Prospective Studies
  • Pulmonary Veins / diagnostic imaging
  • Pulmonary Veins / surgery*
  • Treatment Outcome
  • Ultrasonography, Interventional