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Background: It has been observed that the fourth‐generation cryoballoon (CB4) ablation catheter increased the rate of acute real‐time recordings of pulmonary vein isolation (PVI) during the ablation for the treatment of atrial fibrillation (AF). The aim of this analysis was to compare the long‐term outcome results between patients treated with the CB4 and second‐generation cryoballoon (CB2). Methods: In total, 492 patients suffering from AF, underwent PVI ablation with either the CB2 or CB4 catheter within this examination of the 1STOP real‐world Italian project and were included in the analysis. Specifically, 246 consecutive patients treated by CB4 were compared to 246 propensity‐matched control patients who underwent PVI using CB2. Results: When comparing the patient cohorts treated with CB2 versus CB4, acute success rate (99.6 ± 4.7% vs. 99.7 ± 3.6%, p =.949) and peri‐procedural complications (3.7% vs.1.2%, p =.080) were similar in both groups, respectively. However, procedure time (100 vs.75 min, p <.001) and fluoroscopy duration (21 vs.17 min, p <.001) were all significantly lower in the CB4 treated patient cohort. At the 12‐month follow‐up, the freedom from AF recurrence after a 90‐day blanking period was significant higher in the CB4 as compared with the CB2 group (93.3% vs.81.3%, p <.001). Conclusions: In summary, usage of the CB4 ablation catheter increased the rate of acute PVI recording capability and resulted in a higher rate of long‐term PVI success, as demonstrated by the reduced rate of AF recurrence in comparison to the CB2 cohort at the 12‐month follow‐up period. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence., Methods: Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging., Results: Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390)., Conclusions: In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.