Heart and Vessels

, Volume 33, Issue 9, pp 1052–1059 | Cite as

Additional cryoapplications at the pulmonary vein antrum using a 28-mm second-generation cryoballoon: a pilot study of extra-pulmonary vein ablation

  • Shinsuke MiyazakiEmail author
  • Takatsugu Kajiyama
  • Tomonori Watanabe
  • Sadamitsu Ichijo
  • Yoshito Iesaka
Original Article


Isolation areas post-28-mm cryoballoon pulmonary vein isolation (CB-PVI) are smaller than post-radiofrequency PV antrum isolation at the left superior PV (LSPV) antrum and recurrent atrial fibrillation (AF) can originate from this area. This pilot study evaluated the impact of additional extra-PV CB applications at the LSPV antrum following conventional CB-PVI. Eighteen paroxysmal AF patients underwent CB-PVI with single 3-min freeze techniques. Following the CB-PVI, 2-min CB applications were added once or twice at the LSPV antrum. Before and after extra-PV ablation, left atrial (LA) 3-D electroanatomical maps were created. Seventy-two total PVs were successfully isolated with 4.2 ± 0.4 applications/patient with 28-mm CBs. The mean LA posterior wall (LAPW) and non-isolated LAPW areas were 14.9 ± 3.6 and 6.9 ± 2.8 cm2, respectively. After 1.6 ± 0.5 mean extra-PV applications, the upper non-isolated LAPW area significantly decreased from 3.3 ± 1.8 to 2.5 ± 1.8 cm2 (p < 0.001). The lowest esophageal temperatures during the extra-PV ablation were 27 °C. The total procedure and fluoroscopic times were 72.8 ± 13.1 and 15.2 ± 5.9 min, respectively. Silent gastric hypomotility was detected in 2/9 patients 1 day later, and mild PV stenosis was observed in 4/72 PVs 3 months later, but did not progress. At 12-month after single procedures, 16 (88.9%) patients were free from recurrent AF off antiarrhythmic drugs. A median of 8.0 [6.0–10.0] months later, PV reconnections were detected in 3/12 (25.0%) PVs. The non-isolated LAPW area was significantly larger in the chronic than acute phase (14.3 ± 5.2 cm2, p = 0.016). This pilot study suggested the potential feasibility of additional LSPV antral cryoapplications following a conventional CB-PVI. The strategy warrants further study in more patients.


Cryoballoon Pulmonary vein isolation Atrial fibrillation Catheter ablation 



We would like to thank Mr. John Martin for his help in the preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Financial support



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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Shinsuke Miyazaki
    • 1
    • 2
    Email author
  • Takatsugu Kajiyama
    • 2
  • Tomonori Watanabe
    • 2
  • Sadamitsu Ichijo
    • 2
  • Yoshito Iesaka
    • 2
  1. 1.Department of Cardiovascular MedicineFukui UniversityFukuiJapan
  2. 2.Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan

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