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Background: Systematic use of a 28mm balloon has been proposed for pulmonary vein cryoisolation in patients with atrial fibrillation., Objective: To assess the results of a dual balloon size strategy using a 23 or 28mm cryoballoon catheter for pulmonary vein isolation., Methods: A total of 118 patients (mean age 56 ± 10 years) with paroxysmal (n=85) or persistent atrial fibrillation (n=33) were enrolled. Patients with four pulmonary veins<20mm in diameter were isolated with a 23mm cryoballoon (n=29); patients with one pulmonary vein diameter ≥20mm were isolated with a 28mm cryoballoon (n=89)., Results: No significant difference in procedural variables was observed between the two groups. AF-free survival, after a mean follow-up of 19.9 ± 5 months, was similar in the two groups (69% vs 62%; p=0.57 and between patients with paroxysmal atrial fibrillation (68% vs 68%; p=0.91) or persistent AF (75% vs 48%; p=0.60). AF duration before the ablation procedure (p=0.005) was an independent predictor of AF recurrence. Phrenic nerve palsy rate was not statistically different in the two groups (4 [14%] vs 9 [10%]; p=0.73). The temperature in the right superior pulmonary vein (p=0.008) was an independent predictor of phrenic nerve palsy. Five patients developed left atrial flutter with the 28mm diameter balloon versus none with the 23mm balloon., Conclusions: A dual balloon size strategy was not associated with a lower AF-free survival or a higher procedure-related complication rate in patients in whom the 23mm balloon was used. Pulmonary vein isolation with a 23mm cryoballoon catheter appears to be an appropriate option in selected patients with small pulmonary vein diameters., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Transcatheter cryoablation is an alternative option for the treatment of supraventricular tachycardia, due to its very low risk of permanent atrio-ventricular block. However, the overcost of cryocatheter and the high recurrence rate of this emerging technology braked its large use. This study reports the results of an approach using cryoablation for the treatment of junctional tachycardia (JT) in selected patients at high risk of atrio-ventricular (AV) block., Patients and Methods: Out of a series of 199 patients with JT treated by catheter ablation, 26 benefited from cryoablation (mean age 32.8+/-15 years, 15 males). The indications were the presence of an accessory pathway with a high risk of atrio-ventricular block (n=7), a slow pathway difficult to ablate, with a risk of atrio-ventricular block (n=7), a recurrence after a RF procedure, during which a transient atrio-ventricular block has occurred (n=4), and finally patients at young age (n=8)., Results: The primary success rate was 92%. No permanent AV block has been reported, neither with RF nor with cryoablation. The recurrence rate at 9+/-10 months was at 29% after cryoablation and 8.6% after RF. In case of AV nodal reentrant tachycardia, the additional cost of cryotherapy catheter has been avoided in 76.85% of cases. The use of a cryotherapy catheter and RF catheter has been necessary for the remaining cases., Conclusion: This study demonstrates that an approach, reserving cryoablation in selected patients at high risk of AV block is an alternative strategy to "the systematic use" of cryotherapy in the ablation of JT with a high efficacy, an excellent safety and a reduced cost.