{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T16:30:28Z","timestamp":1782577828506,"version":"3.54.5"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T00:00:00Z","timestamp":1707177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at first repeat ablation were studied in 400 AF patients in a propensity-matched analysis (age, AF type, CHA2DS2-VASc score) between Achieve catheter-guided CBA with additional EnSite LA voltage maps performed pre- and post-CBA (mapping group; N = 200) and CT- and Achieve catheter-guided CBA (control group; N = 200). Clinical success was defined as freedom of documented AF or atrial tachycardia (AT) &gt; 30 s. PV reconnection patterns were characterized in repeat ablations. Results: At 1 year, 77 (19.25%) patients had recurrence of AF\/AT, significantly lower than in the mapping group: 21 (10.5%) vs. 56 (28%), p &lt; 0.001. Procedure time was shorter (72.2 \u00b1 25.4 vs. 78.2 \u00b1 29.3 min, p = 0.034) and radiation exposure lower (4465.0 \u00b1 3454.6 Gy.cm2 vs. 5940.5 \u00b1 4290.5 Gy.cm2, p = 0.037). Use of mapping was protective towards AF\/AT recurrence (HR = 0.348; 95% CI 0.210\u20130.579; p &lt; 0.001), independent of persistent AF type (HR = 1.723; 95% CI 1.034\u20132.872; p = 0.037), and LA diameter (HR = 1.055; 95% CI 1.015\u20131.096; p = 0.006). At repeat ablation (N = 90), persistent complete PVI was seen in 14\/20 (70.0%) versus 23\/70 (32.9%) in the mapping and conventional group, respectively (p = 0.03). Reconnection rate of the right inferior PV was lower with mapping (10.0% vs. 34,3%, p = 0.035). Conclusions: Adding electroanatomical LA voltage mapping to CBA improves 1-year clinical outcome and lowers both procedure time and radiation exposure. At repeat, use of mapping increases complete persistent PVI mainly by improving PVI durability of the RIPV.<\/jats:p>","DOI":"10.3390\/jcdd11020057","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T12:38:24Z","timestamp":1707223104000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Adding Electroanatomical Mapping to Cryoballoon Pulmonary Vein Isolation Improves 1-Year Clinical Outcome and Durability of Pulmonary Vein Isolation: A Propensity Score-Matched Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Maxime","family":"Tijskens","sequence":"first","affiliation":[{"name":"Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium"},{"name":"AZ Rivierenland Hospital, 2840 Bornem, Belgium"},{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Abugattas","sequence":"additional","affiliation":[{"name":"CHU UCL Namur, Site Sainte-Elisabeth, 5000 Namur, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Thoen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium"},{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antanas","family":"Strazdas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium"},{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Schwagten","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium"},{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"De Greef","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium"},{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation","volume":"374","author":"Kuck","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1093\/europace\/euab029","article-title":"Cryoballoon ablation vs. antiarrhythmic drugs: First-line therapy for patients with paroxysmal atrial fibrillation","volume":"23","author":"Kuniss","year":"2021","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1056\/NEJMoa2029980","article-title":"Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation","volume":"384","author":"Andrade","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1056\/NEJMoa2029554","article-title":"Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation","volume":"384","author":"Wazni","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.ijcard.2018.05.135","article-title":"Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation","volume":"270","author":"Conte","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.joa.2016.10.562","article-title":"Pulmonary vein potential mapping in atrial fibrillation with high density and standard spiral (lasso) catheters: A comparative study","volume":"33","author":"Meissner","year":"2017","journal-title":"J. Arrhythm"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1093\/europace\/eux129","article-title":"Pulmonary vein re-mapping after cryoballoon ablation for atrial fibrillation","volume":"20","author":"Yokoyama","year":"2018","journal-title":"Europace"},{"key":"ref_8","first-page":"923","article-title":"Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (the Achieve Plus study)","volume":"66","author":"Tijskens","year":"2023","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/pace.13709","article-title":"Over-the-needle trans-septal access using the cryoballoon delivery sheath and dilator in atrial fibrillation ablation","volume":"42","author":"Stroker","year":"2019","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1161\/01.CIR.0000121734.47409.AA","article-title":"Electrophysiological and electroanatomic characterization of the atria in sinus node disease: Evidence of diffuse atrial remodeling","volume":"109","author":"Sanders","year":"2004","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.jacc.2004.10.035","article-title":"Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: An independent predictor of procedural failure","volume":"45","author":"Verma","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s10840-017-0304-0","article-title":"Impact of 3D mapping on procedural characteristics and outcomes in cryoballoon pulmonary vein isolation for atrial fibrillation","volume":"51","author":"Guhl","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1093\/europace\/eut366","article-title":"Real-time assessment of pulmonary vein disconnection during cryoablation of atrial fibrillation: Can it be \u2018achieved\u2019 in almost all cases?","volume":"16","author":"Boveda","year":"2014","journal-title":"Europace"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1093\/europace\/eus041","article-title":"Pulmonary vein isolation during cryoballoon ablation using the novel Achieve inner lumen mapping catheter: A feasibility study","volume":"14","author":"Chierchia","year":"2012","journal-title":"Europace"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1093\/europace\/eus189","article-title":"Verification of pulmonary vein isolation during single transseptal cryoballoon ablation: A comparison between the classical circular mapping catheter and the inner lumen mapping catheter","volume":"14","author":"Chierchia","year":"2012","journal-title":"Europace"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1007\/s10840-023-01538-4","article-title":"The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2","volume":"66","author":"Sofianos","year":"2023","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.acvd.2019.05.006","article-title":"The challenging right inferior pulmonary vein: A systematic approach for successful cryoballoon ablation","volume":"112","author":"Martins","year":"2019","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1093\/europace\/eux252","article-title":"Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy: A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS)","volume":"19","author":"Sarkozy","year":"2017","journal-title":"Europace"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"euad191","DOI":"10.1093\/europace\/euad191","article-title":"Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: A European Heart Rhythm Association review","volume":"25","author":"Sommer","year":"2023","journal-title":"Europace"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/j.hrthm.2021.04.020","article-title":"Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III","volume":"18","author":"Aryana","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e011780","DOI":"10.1161\/CIRCEP.122.011780","article-title":"Paroxysmal Atrial Fibrillation Ablation Using a Novel Variable-Loop Biphasic Pulsed Field Ablation Catheter Integrated With a 3-Dimensional Mapping System: 1-Year Outcomes of the Multicenter inspIRE Study","volume":"16","author":"Duytschaever","year":"2023","journal-title":"Circ. Arrhythm Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1111\/pace.14494","article-title":"Second versus fourth generation of cryoballoon catheters: The 1STOP real-world multicenter experience","volume":"45","author":"Manfrin","year":"2022","journal-title":"Pacing Clin. Electrophysiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/2\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:55:59Z","timestamp":1760104559000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/2\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,6]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["jcdd11020057"],"URL":"https:\/\/doi.org\/10.3390\/jcdd11020057","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,6]]}}}