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

Abstract

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.