{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:43:36Z","timestamp":1768815816314,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,2,23]],"date-time":"2019-02-23T00:00:00Z","timestamp":1550880000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The left atrial (LA) posterior wall (LAPW) has been targeted to improve the clinical outcomes in patients with persistent atrial fibrillation (PersAF). This study aimed to investigate the feasibility, safety, and clinical implications of cryoballoon (CB) applications on the LAPW to accomplish electrical isolation (EI) of the LAPW with CB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 100 patients (males, 84; mean age, 64\u2009\u00b1\u200910 years) with PersAF were enrolled. The first 50 patients underwent only pulmonary vein isolation (PVI) (PVI\u2010only group) and the remaining 50 patients underwent PVI and EI of the LAPW with CB (EI\u2010LAPW group).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One\u2010year sinus rhythm maintenance probability was significantly higher in the EI\u2010LAPW group than in PVI\u2010only group (80.0% vs 55.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.01). The success rate of constructing an LA roof block line (LA\u2010RB), bottom block line, and EI of the LAPW was 92%, 60%, and 58%, respectively. The nadir CB temperature (\u221245\u00b0C\u2009\u00b1\u20094\u00b0C vs \u221239\u00b0C\u2009\u00b1\u20095\u00b0C, \n<jats:italic>P<\/jats:italic>\u2009=\u20090.005) and anatomical angle of the left atrial roof (106\u00b0C\u2009\u00b1\u200930\u00b0C vs 144\u00b0C\u2009\u00b1\u200917\u00b0C, \n<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) significantly predicted the successful LA\u2010RB construction. The left ventricular ejection fraction was significantly higher in unsuccessful cases than in successful cases of an EI of the LAPW (64%\u2009\u00b1\u20098% vs 58%\u2009\u00b1\u200911%, \n<jats:italic>P<\/jats:italic>\u2009=\u20090.041). Even though the EI of the LAPW was unsuccessful, CB freezing in LAPW significantly debulked the nonscar area (\u22650.1\u2009mV) in LAPW (18.1\u2009\u00b1\u20095.6 vs 2.2\u2009\u00b1\u20093.1\u2009cm\n<jats:sup>2<\/jats:sup>, \n<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and provided the equivalent 1\u2010year outcome of successful cases (79.3% vs 81.0%, \n<jats:italic>P<\/jats:italic>\u2009=\u20090.90).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of PVI and EI of the LAPW with CB provided better clinical outcomes than conventional PVI procedure for patients with PersAF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13879","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T03:59:17Z","timestamp":1550203157000},"page":"805-814","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["The clinical impact of the left atrial posterior wall lesion formation by the cryoballoon application for persistent atrial fibrillation: Feasibility and clinical implications"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0234-390X","authenticated-orcid":false,"given":"Takuro","family":"Nishimura","sequence":"first","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuteru","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideshi","family":"Aoyagi","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1781-9218","authenticated-orcid":false,"given":"Takatoshi","family":"Shigeta","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rena","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsumi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsutoshi","family":"Asano","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomofumi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidetoshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsukasa","family":"Shimura","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Kurabayashi","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehiko","family":"Keida","sequence":"additional","affiliation":[{"name":"Department of Cardiology Edogawa Hospital Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuo","family":"Sasano","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenzo","family":"Hirao","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8202-9442","authenticated-orcid":false,"given":"Kaoru","family":"Okishige","sequence":"additional","affiliation":[{"name":"Heart Center Japan Red Cross Yokohama City Bay Hospital Yokohama 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