Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 2:S1547-5271(25)02346-X.
doi: 10.1016/j.hrthm.2025.04.027. Online ahead of print.

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

Adolfo Fontenla  1 , Rocío Cozar  2 , Gonzalo Fernández-Palacios  3 , Pablo J Sánchez-Millán  4 , Jesús I Jiménez-López  5 , Larraitz Gaztañaga  6 , Gabriel Ballesteros  7 , José J García-Salvador  8 , David González-Casal  9 , Álvaro Izquierdo-Bajo  2 , Francisco J García-Fernández  3 , Miguel Álvarez  4 , Jorge González-Panizo  9 , Nina Soto Flores  9 , Tomás Datino  9 , José A Cabrera  9 ; POLAR-WAVE Investigators (Appendix)
Collaborators, Affiliations

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

Adolfo Fontenla et al. Heart Rhythm. .

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.

Keywords: Atrial fibrillation; Contrast-free ablation; Cryoablation; Multicenter study; Pressure waveform; Pulmonary veins isolation.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr. Adolfo Fontenla received speaker’s honoraria from Boston Scientific and Proctor’s fees from Medtronic. Dr. Rocío Cozar received fees for consulting agreements with Boston Scientific. All remaining authors have no conflicts of interest to disclose.