Analysis of the Effectiveness of the Latest 4th Generation Cryoballoon Catheters in Pulmonary Vein Isolation Using High-Resolution Mapping

BackgroundLong-term data showed that up to 27% of pulmonary veins are reconnected using cryoballoon ablation. This study aims to evaluate the efficacy of the latest 4th generation cryoballoon catheters using ultra high-resolution mapping.MethodsIn patients with AF, a standard PVI with the latest 4th generation cryoballoon catheter (Arctic Front Advance PRO, Medtronic Minneapolis, USA) and the spiral mapping catheter (Achieve Advance, Medtronic, Minneapolis, MN, USA) was performed. Subsequently, high-resolution mapping was achieved using the novel multipolar grid mapping catheter (Advisor HD Grid SE, Abbott Laboratories; USA). Follow-up was obtained after 6 months by means of a 7-day Holter ECG.ResultsIn our study, acute PVI was successfully achieved in all 31 patients. The latest 4th generation cryoballoon catheter is safe in the acute phase of PVI. Additional high-resolution mapping (mean points per map 21001 ± 4911) using the multipolar grid mapping catheter enabled us to identify residual gaps only in the carina PV region; therefore, no additional ablation was performed. Three out of 31 patients (10%) presented with atrial arrhythmia recurrence always related with PV reconnection; using high-resolution mapping had no additional benefit in identifying pulmonary veins in which reconnection will occur.ConclusionThe utility of additional high-density mapping, facilitated by the HD Grid catheter following PVI with the fourth-generation cryoballoon catheter do not substantiate a discernible advantage over conventional mapping methodologies, particularly the spiral mapping catheter. Residual carinal conduction was observed in a substantial cohort of patients (48%), highlighting a persistent challenge in achieving complete electrical isolation.