Impact of Expandable Cryoballoon on Pulmonary Vein Morphology and Treatment Selection in Atrial Fibrillation Ablation

BACKGROUND: Cryoballoon (CB) ablation is widely used for pulmonary vein isolation (PVI). A novel CB (POLARx-FIT) that can be expanded from 28 to 31 mm has recently been introduced. However, its impact on pulmonary vein (PV) morphology, acute lesion characteristics, and treatment selection remains unclear. METHODS: Among 416 consecutive patients undergoing PVI for atrial fibrillation, after excluding radiofrequency catheter ablation (RFCA) cases and CB ablation with Arctic Front Advance, 190 patients were included: a 28 mm CB group (POLARx, N = 122) and a 31 mm CB group (POLARx-FIT, N = 68). PV morphology was assessed on preoperative computed tomography. Lesion size of the CB was evaluated using post-ablation voltage mapping. RESULTS: , p < 0.01). One-year atrial tachyarrhythmia recurrence was not significantly different between groups (p = 0.62) CONCLUSION: Despite inclusion of patients with larger PVs, the 31 mm CB was associated with a larger PVI lesion, with similar 1-year recurrence. The introduction of a 31 mm CB expanded CB eligibility and reduced the need for RFCA in the real-world practice.