Delivery of a “bonus” application after the pulmonary vein isolation (PVI) using cryoballoon (CB) catheter is still routine practice despite clear evidence regarding its efficacy.

To assess the one year results of paroxysmal (PAF) and short persistent atrial fibrillation (SpAF) ablation using the last generation Arctic Front Advance^® CB catheter without bonus application.

All consecutive patients who underwent CB ablation for PAF and SpAF in Rouen university hospital between June 2012 and March 2015 were enrolled. Duration of CB application was set to 240sec, and no bonus applications were performed after PVI. Patients were seen in outpatient clinic, and underwent ECG and a 24-hour recording at 4 and 12 months.

Population consisted of 170 patients (male=74.1%; mean age=57.8±10.2 years). The mean duration of AF was 4.3±4.0 years. The mean CHA₂DS₂VASC score was 1.2±1.2. A 28mm balloon was used in 146 (85.9%) and 655 (99.2%) PVs were isolated with the CB only. Mean number applications were 1.4±0.7, 1.6±1.1, 1.3±0.7, 1.5±0.6, 1.1±0.3, 3.65±3.0, for right superior PV, right inferior PV, left superior PV, left inferior PV supernumerary veins and common ostia respectively. Mean procedure and fluoroscopy times were 88.5±28.2 and 14.1±8.6min respectively. Phrenic nerve palsy occurred during the procedure in 7 patients (4.1%). Tamponade occurred in 3 patients (1.8%) and pericardial effusion was observed in 7 patients (4.1%). Sixteen patients (9.4%) underwent a redo procedure for symptomatic atrial arrhythmia. The 1-year follow-up was completed in 163 (95.9%) patients. The majority (128/163, 78.5%) were asymptomatic. AF was documented in 15 patients (9%). Anti-arrhythmic drugs were stopped in 140 (85.8%) patients and anticoagulant therapy in 86 (52.7%).

Our results suggest that CB bonus application is not required. This strategy could shorten procedure, fluoroscopy time and improve safety.