{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:56:55Z","timestamp":1770836215883,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The second\u2010generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The novel fourth\u2010generation cryoballoon (CB4) incorporates a 40% shorter distal tip. This design change may translate into an increased rate of PVI real\u2010time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Three hundred consecutive patients with paroxysmal or persistent atrial fibrillation were prospectively enrolled. The first 150 consecutive patients underwent CB2 based PVI (CB2 group) and the last 150 consecutive patients were treated with the CB4 (CB4 group). A total of 594\/594 (100%, CB4) and 589\/594 (99.2%, CB2) pulmonary veins (PVs) were successfully isolated utilizing the CB4 and CB2, respectively (<jats:italic>p<\/jats:italic>\u2009=\u2009.283). The real\u2010time PVI visualization rate was 47% (CB4) and 39% (CB2; <jats:italic>p<\/jats:italic>\u2009=\u2009.005) and the mean freeze cycle duration 200\u2009\u00b1\u200990\u2009s (CB4) and 228\u2009\u00b1\u2009110\u2009s (CB2; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), respectively. The total procedure time did not differ between the groups (CB4: 64\u2009\u00b1\u200932\u2009min) and (CB2: 62\u2009\u00b1\u200929\u2009min, <jats:italic>p<\/jats:italic>\u2009=\u2009.370). No differences in periprocedural complications were detected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A higher rate of real\u2010time electrical PV recordings are seen using the CB4 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15009","type":"journal-article","created":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T11:45:01Z","timestamp":1616586301000},"page":"1553-1560","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Experience and procedural efficacy of pulmonary vein isolation using the fourth and second generation cryoballoon: The shorter, the better?"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9014-8097","authenticated-orcid":false,"given":"Christian\u2010Hendrik","family":"Heeger","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan\u2010Eric","family":"Bohnen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorin","family":"Popescu","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy  Bucharest Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roza","family":"Meyer\u2010Saraei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6665-7326","authenticated-orcid":false,"given":"Thomas","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Sciacca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Kirstein","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha","family":"Hatahet","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck 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Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl\u2010Heinz","family":"Kuck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"},{"name":"LANS Cardio  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Eitel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Vogler","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0122-7130","authenticated-orcid":false,"given":"Roland","family":"Richard Tilz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II University Heart Center L\u00fcbeck, University Hospital Schleswig\u2010Holstein  L\u00fcbeck Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck  L\u00fcbeck 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