Introduction: Left atrial (LA) roof ablation using the cryoballoon technique, combined with pulmonary vein isolation (PVI), has been reported to be beneficial for ablation therapy in patients with persistent atrial fibrillation (AF). Left posterior wall ablation also results in improved patient outcomes. However, the contribution of these techniques to the success of cryoballoon ablation (CBA) treatment of AF is not known. The present study examined the influence of the roofline block and isolation area on outcomes after CBA. Methods and Results:We enrolled 78 patients with persistent AF. LA roof ablation was performed using a 28-mm cryoballoon with a single freezing of 3 minutes at each region (median number of freezes: 4) after PVI. After CBA, bipolar voltage amplitude mapping was performed during sinus rhythm using the NavX mapping system.Patients were divided into two subgroups according to the voltage and activation map: the roof-conduction (n = 46) and roofline-block groups (n = 32). Atrial tachyarrhythmia recurred in 20 patients of the conduction group and 4 patients of the roofline-block group. The rate of 12-month freedom from tachyarrhythmia after a single ablation procedure was 78% (95% confidence interval [CI], 60%-89%) in the roofline-block group and 45% (95% CI, 30%-60%) in the conduction group (P = .048).Cox proportional hazard analysis revealed that the isolated area was not a significant predictor of recurrence (hazard ratio, 0.94; 95% CI, 0.86-1.02; P = .15). Conclusion:Creating a complete roofline block is the major factor predicting the maintenance of sinus rhythm in patients with persistent AF. K E Y W O R D S ablation, atrial fibrillation, pulmonary vein, roofline block, sinus rhythm

Extensive isolation is superior to individual isolation for achieving freedom from atrial arrhythmia in long term follow-up by CBA. Evaluating PV diameter at the left atrial PV junction is essential for applying CBA.

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We achieved successful catheter cryoablation in a patient with para‐Hisian premature ventricular contractions (PVCs) without conduction disturbance using the freeze‐thaw‐freeze method while observing the atrial‐His bundle interval. Cryoablation could be considered an alternative to radiofrequency ablation for patients with para‐Hisian PVCs.

To determine the efficacy of the medical interview and the coronary risk factor profile in differentiating vasospastic angina from other causes of chest pain, we examined 59 patients who underwent diagnostic coronary angiography with selective intracoronary injection of acetylcholine. In the medical interview, a questionnaire on the characteristics of chest pain and additional symptoms was given. Weexamined coronary risk factors from laboratory tests, life history, and physical examination. Chest pain accompanied by cold sweat and occurring in the early morning was the only significant discriminating information; the location of pain and the duration were not discriminating.Classic coronary risk factors did not differ between vasospastic angina and noncardiac chest pain except for gender. Weconclude that history taking is the most important means to distinguish vasospastic angina from other causes of chest pain. (Internal Medicine 36: 676-679, 1997)