Ablation of paroxysmal atrial fibrillation (PAF) using a cryo-balloon catheter is currently expanding. The success rate of ablation with the Arctic Front® cryoballoon has been found to be similar to what was observed with radiofrequency catheter.The recent use of the new catheter Arctic Front Advance® seems to improve this performances. We postulate that this new generation of catheter could decrease the rate of redo procedures and maintain more effectively the pulmonary vein (PV) isolation.

From January 2009 to April 2014, we prospectively collected data regarding all consecutive patients referred for PAF ablation with cryoballoon technology at our institution. Patients were assigned either to 1stCB group if the arctic front catheter was used (from January 2009 to June 2012) or to the 2ndCB group if the arctic front advance catheter was used (from jully 2012 to April 2014). We performed a follow up of one year in each group and we compared the number of redo procedures and their characteristics.

We included 106 patients in borh groups.Characteristics of the population are described in table 1. The rate of redo procedures at one year was significantly lower in the 2ndCB group (9.4% vs 37%; p<0.01).

When a redo procedure was performed, the average number of reconnected PV was 2.2 in the 2ndCB group and 2.8 in 1stCB group (p=0.14). In the 2ndCB group, PV reconnection occurred more frequently the inferior PVs (right inferior PV=90%, left inferior PV=63%, right superior PV 30% and left superior PV=15%). This difference of distribution is less pronounced in the 1stCB group (LIPV=90%, RIPV=65%, RSPV=58% and the LSPV=55%).

The new generation of cryoballoon significantly decreased the rate of redo procedures at one year. Using the second generation CB, pulmonary vein reconnection was more frequently observed with the inferior PV. This could probably be explained by the anatomical characteristics of these veins (figure next page).