Purpose: The cryoballoon technology has the potential to isolate a pulmonary vein (PV) with a single energy application. However, using the first-generation cryoballoon (CB1) repeated freezing is often necessary. The novel second-generation cryoballoon (CB2) features a widened zone of optimal cooling comprising the whole frontal hemisphere. The aim of this study was to investigate the impact of the novel CB2 on procedural efficacy of cryoballoon PV isolation (CB-PVI).
Methods and Results: CB-PVI using a single big balloon (28 mm) and an endoluminal mapping catheter (Achive-Medtronic) was performed in 46 consecutive patients with paroxysmal or short-term persistent atrial fibrillation: 23 with the CB1 (300 seconds application time) and 23 with the CB2 (180-240 seconds application time). When compared to the CB1, using the CB2 increased single-shot PVI rate from 56% to 85% (P < 0.01) and decreased procedure duration (190 ± 26 vs 139 ± 32 minutes; P < 0.01), and fluoroscopy exposure time (35.7 ± 8.3 vs 23.4 ± 5.4 min; P = 0.01). Time to PVI was shorter in the CB2 group (68 ± 28 vs. 49 ± 26 second). The need of pull-down maneuver also evaluated with intracardiac echo decreased from 16% in the CB1 to 4% in the CB2.

Conclusions: the CB2 significantly improved procedural efficacy compared to the CB1.