Our data strengthen the value of CB ablation for the treatment of AF as an effective and safe procedure in elderly patients, with similar success and complication rates when compared with a younger population.

recommendations for HF patients with reduced LVEF (HFrEF) are deliberative because of the limited data. Recently, the CASTLE-AF study showed that RF-based catheter ablation for AF in patients with reduced LVEF was associated with lower rates of all-cause mortality and hospitalization for worsening HF. 5 Point-by-point ablation by RF often results in a favorable clinical outcome, but its complexity demands a long learning curve and relatively long procedural duration. In this context the 2nd-generation cryoballoon (CB2, Arctic Front Advance, Medtronic Inc., A trial fibrillation (AF) and heart failure (HF) often coexist and AF increases the risk of hospitalization because of decompensated HF in those patients. 1-3 Pulmonary vein isolation (PVI) is the cornerstone of invasive AF treatment. Radiofrequency (RF)-based catheter ablation for HF patients, compared with amiodarone therapy, significantly reduces recurrent AF and improves left ventricular ejection fraction (LVEF) in selected cases. 4 Although current guidelines recommend ablation therapy to maintain sinus rhythm (SR) for symptomatic AF patients,

Incorporating RF current power, the non-linear AI provides more comprehensive information during PVI compared with FTI. Given that the FTI for a given AI varies widely, the value of FTI in clinical practice is questionable.

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Background: Data regarding atrial tachycardia (AT) following second-generation cryoballoon ablation (CBA) of atrial fibrillation (AF) are limited. Aim: To describe the incidence, mechanisms, and clinical predictors of ATs following CBA. Methods and results: In this retrospective single-center study 238 patients undergoing CBA for treatment of paroxysmal (91/238; 38.2%) or persistent AF were analyzed. During a mean follow-up of 11.9 AE 5.5 months recurrence of AF occurred in 49/238 patients (20.6%) and AT in 27/238 (11.3%). Twenty-six patients with AT and 14 with AF only underwent a redo ablation. The prevailing mechanism of AT was macroreentry [typical atrial flutter (AFL) (n = 10), left atrial macroreentry (n = 14), focal left-AT (n = 2)]. Non-cavotricuspid-isthmus-dependent macroreentry right-AT was mapped and ablated in 3 patients after initial AFL ablation. In a multivariate regression model, persistent type of AF (HR = 3.3; CI = 1.2-9.4), cardiomyopathy (HR = 3.5; CI = 1.5-8.4), treatment with beta-blockers (HR = 0.3; CI = 0.1-0.6), and pulmonary vein-abnormality (HR = 4.6; CI = 2.1-10.4) were independent predictors of AT. Substrate analysis revealed a significantly higher number of low voltage areas in the left atrium in patients with left-AT in comparison to patients with AF recurrence only (2.0; IQR=2.0À4.0 vs. 0.5; IQR = 0.0-2.25; p = 0.005). Conclusion:In this study, AT after CBA occurred in 11.3% of patients with macroreentry being the prevalent mechanism. All patients with left-AT presented with low voltage areas in the left atrium, suggesting a more progressive underlying fibrotic disease in these patients.