Cryoablation of pulmonary veins guided by pressure waveform analysis: Intra-procedural and long-term outcomes.

BACKGROUND

Cryoballoon ablation requires optimal pulmonary vein (PV) occlusion, conventionally assessed via iodine contrast injection. This method carries risks such as renal injury and allergic reactions and often requires a second operator. Pressure waveform analysis offers a real-time, contrast-free alternative to cryoballoon ablation.

OBJECTIVE

To evaluate the acute efficacy, safety, and long-term outcomes of pressure-guided cryoablation in a multicenter, multi-brand setting.

METHODS

This prospective, observational multicenter study included 220 consecutive patients undergoing cryoablation at 9 Spanish hospitals using Arctic Front Advance Pro (Medtronic, Minneapolis) and PolarX (Boston Scientific, Marlborough) systems, guided exclusively by pressure waveform analysis. PV occlusion was classified as type 1 (incomplete) or type 2 (complete). The primary end point was 1-year arrhythmia-free survival; secondary end points included acute PV isolation success, single-shot success, procedural times, symptom improvement, and adverse events.

RESULTS

PV isolation was achieved in 93.7% of patients without contrast. The median procedure and fluoroscopy times were 102 and 23 minutes, respectively. One-year arrhythmia-free survival was 92.2%, with 81.1% of patients experiencing symptom improvement (P < .001). Adverse events were low (0.4% serious, 5.4% minor), including transient phrenic nerve palsy (3.2%). Of 869 PVs treated, 98.5% were isolated, with a single-shot success rate of 76.5%. Type 2 occlusion (80% of cases) was associated with higher isolation success (84.4% vs 46.5%, P < .001).

CONCLUSION

Pressure-guided cryoablation is a safe, effective alternative to contrast-based methods, achieving high acute isolation and long-term success rates. Future randomized studies should further assess its role in clinical practice.