Experience of Atrial Fibrillation Ablation with Third Generation Cryoballoon in a Single Center

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Paroxysmal or persistent atrial fibrillation (n=164). Intervention: Third-generation cryoballoon (Arctic Front Advance ST) pulmonary vein isolation. Primary outcome: Atrial tachyarrhythmia recurrence at 24 months after a 90-day blanking period.

Q: What does this research mean for the field?

Pulmonary vein isolation using the third-generation cryoballoon achieves low 24-month atrial tachyarrhythmia recurrence (21.3%) and a low acute complication rate (3.1%) in patients with paroxysmal or persistent atrial fibrillation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Ümeyir Savur; Aysel Akhundova; Aykun Hakgör; Fatih Erkam Olgun; Emrah Erdoğan; Fethi Kılıçarslan

doi:10.5505/ejm.2026.91297

January 1, 2026Eastern Journal Of MedicineOpen Access

Experience of Atrial Fibrillation Ablation with Third Generation Cryoballoon in a Single Center

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Key result

Third-generation cryoballoon ablation yields a ~21% arrhythmia recurrence rate at 24 months in AF.

n=164

Why the study?

Procedural and 24-month clinical outcomes of PVI using the third-generation cryoballoon for paroxysmal or persistent atrial fibrillation were evaluated.

Does third-generation cryoballoon pulmonary vein isolation provide durable rhythm control and procedural safety at 24 months in patients with paroxysmal or persistent atrial fibrillation?

Key Points

To evaluate the procedural performance and 24-month clinical outcomes of pulmonary vein isolation using the third-generation cryoballoon in paroxysmal and persistent atrial fibrillation.
Retrospective single-center study of 164 patients (mean age 61.2 ± 12.1 years, 37.2% female) with paroxysmal (69.5%) or non-paroxysmal (30.5%) atrial fibrillation treated between March 2019 and February 2022.
Pulmonary vein isolation was performed using the third-generation cryoballoon (Medtronic Arctic Front Advance ST) equipped with a spiral mapping catheter.
Atrial tachyarrhythmia recurrence occurred in 21.3% of patients (n=35) at 24-month follow-up after a 90-day blanking period.
Intraprocedural parameters demonstrated a mean time to pulmonary vein isolation of 52.7 ± 16.3 sec, total procedure time of 43 ± 3.1 min, and fluoroscopy duration of 11 ± 2.1 min.
In-hospital adverse events occurred in 3.1% of patients (n=5), consisting of phrenic nerve injury in 4 patients and pericardial effusion with tamponade in 1 patient.

Study Design

Type

Observational (n=164)

Multicenter

No

Structured PICO

Does third-generation cryoballoon pulmonary vein isolation provide durable rhythm control and procedural safety at 24 months in patients with paroxysmal or persistent atrial fibrillation?

P

Population

164 adults (mean age 61.2 years, 37.2% female) with paroxysmal (69.5%) or persistent atrial fibrillation undergoing third-generation cryoballoon pulmonary vein isolation, followed for 24 months.

E

Exposure

Pulmonary vein isolation (PVI) using the 28-mm third-generation cryoballoon (CB3, Medtronic Arctic Front Advance ST) over an Achieve circular mapping catheter with a single-shot strategy (single 180-second freeze for PVs achieving isolation within 60 seconds, without routine bonus freeze), followed by a 90-day blanking period on anticoagulation and antiarrhythmic therapy

O

Outcome

Atrial tachyarrhythmia (AF, AT, AFL) recurrence (defined as any atrial arrhythmia episode lasting ≥30 seconds occurring beyond the 90-day blanking period) at 24-month follow-upsurrogate

Single-shot pulmonary vein isolation using the third-generation cryoballoon demonstrates short procedure times, a low acute complication rate (3.1%), and a 78.7% freedom from atrial tachyarrhythmia recurrence at 24 months in routine clinical practice.

Limitations

Single-center, retrospective, non-randomized study design
Relatively small sample size (n=164)
Intermittent rhythm monitoring using 24-hour Holter ECG rather than continuous monitoring (e.g., implantable loop recorder), which may underestimate asymptomatic arrhythmia recurrence
Retrospective, single-center, non-randomized design
Intermittent rhythm monitoring using 24-hour Holter ECG recordings rather than continuous monitoring (e.g., implantable loop recorder or 7-day Holter), which may underestimate asymptomatic recurrences

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Implication

May inform real-world AF ablation decisions; leaves open randomized comparisons to prior cryoballoon generations.

Abstract

Study population:We aimed to evaluate the procedural and 24-month clinical outcomes of patients who underwent PVI for paroxysmal atrial fibrillation (pAF) or persistent atrial fibrillation (persAF) using the third-generation cryoballoon (CB3) (Medtronic Arctic Front Advance ST) between March 2019 and February 2022 at İstanbul Medipol University Hospital.The study was conducted in accordance with the principles of the Declaration of Helsinki.Ethical approval was obtained from the İstanbul Medipol University Faculty of Medicine Ethics Committee (EK:2021-1128), and written informed consent

Discussion

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Cite This Study

Savur et al. (2026) conducted an observational in Paroxysmal or persistent atrial fibrillation (n=164). Third-generation cryoballoon (Arctic Front Advance ST) pulmonary vein isolation was evaluated on Atrial tachyarrhythmia recurrence at 24 months after a 90-day blanking period. Third-generation cryoballoon ablation resulted in a 21.3% atrial tachyarrhythmia recurrence rate over 24 months and a 3.1% acute complication rate in patients with atrial fibrillation.

synapsesocial.com/papers/6af0cd87afd0f3f56e51a1f5 https://doi.org/10.5505/ejm.2026.91297

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Experience of Atrial Fibrillation Ablation with Third Generation Cryoballoon in a Single Center

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Experience of Atrial Fibrillation Ablation with Third Generation Cryoballoon in a Single Center

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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