Cryoballoon Pulmonary Vein Isolation: Double Stack vs. Standard Ablation.

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The results of pulmonary vein isolation are limited by arrhythmia recurrence, which is most often due to a failure to effectuate a durable contiguous circumferential transmural lesion around the pulmonary vein (PV) ostia. We postulated that enhancing the index ablation line through use of multiple cryoballoon diameters would be superior to standard ablation with bonus freeze. We enrolled 226 consecutive patients referred for cryoballoon-based PV isolation (PVI). Patients underwent PVI with either the 28-mm Arctic Front Advance cryoballoon using two 4-minutes freezes (Standard group) or with the PolarX FIT cryoballoon using 3-minute freezes in both the 28 and 31-mm diameter configuration (Double Stack group). Patients were followed for 1 year. Primary outcome was atrial tachyarrhythmia recurrence, with procedural complications, cardioversion, ER visit, hospitalization, and repeat ablation being secondary outcomes. A total of 226 patients were included (70% male, 47% persistent AF). Patients in the double stack group had a significantly greater freedom from recurrent AT/AF/AFL at one year (85.1% vs. 65.3%; P=0.008; HR 0.42, 95%CI 0.25-0.74). Periprocedural complications were similar between groups (5.2% vs. 3.4%, P=0.50). At one year there was no difference in cardioversion (12.8% vs. 20.3%, P=0.20), Emergency Room Visit (9.0% vs. 15.5%, P=0.22), or all-cause hospitalization (1.3% vs. 2.7%, P=0.66). Significantly less patients treated with double stack underwent repeat ablation (1.3% vs. 13.5%, P=0.002). In a mixed cohort of patients with paroxysmal and persistent AF, Cryoballoon ablation using the double stack technique is associated with lower rates of AF recurrence and lower rates of repeat ablation.