Pulmonary vein isolation with Mesh Ablator versus Cryoballoon Catheters: 6-month outcomes

  • Robert HofmannEmail author
  • Simon Hönig
  • Franz Leisch
  • Clemens Steinwender



We sought to compare the results of pulmonary vein (PV) ablation using the high-density Mesh Ablator catheter (MESH) versus the cryoballoon (CRYO).

Methods and results

From August 2007 to November 2009, all patients with paroxysmal atrial fibrillation scheduled for a first procedure of PV isolation were screened by cardiac computed tomography for anatomical suitability to undergo ablation with a circumferential ostial ablation catheter. The procedure was finally performed in 79 out of 120 patients matching the criteria of four clearly separated PVs with an ostial diameter of 15–25 mm. The first consecutive 43 patients were treated with the MESH; the following 36 consecutive patients were treated with the CRYO. The procedures were performed with up to 900 s of either pulsed radiofrequency energy delivered by the MESH or cryoenergy applied with the CRYO. The clinical success rate was evaluated 6 months after a single procedure. Isolation of all PVs could be achieved in 40 patients (93%) in the MESH group compared to 31 patients (89%) in the CRYO group (p = ns). Major complications consisted of one tamponade in the MESH group and one reversible phrenic nerve palsy in the CRYO group. After 6 months, the clinical success rate was 44% (19/43 P) in the MESH versus 69% (25/36 P) in the CRYO group (p < 0.05).


Both methods of simplified circumferential PV ablation reveal a high acute success rate. The clinical 6-month results of the MESH are statistically significant inferior compared to the CRYO.


Atrial fibrillation Catheter ablation Pulmonary veins MESH catheter Cryoballoon 


Conflicts of interest

All authors declare that there is no potential conflict of interest.


  1. 1.
    Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.CrossRefPubMedGoogle Scholar
  2. 2.
    Gerstenfeld, E. P. (2007). Persistent pulmonary vein isolation: The elusive goal of atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 18, 392–398.CrossRefGoogle Scholar
  3. 3.
    Di Biase, L., Elayi, C. S., Fahmy, T. S., Martin, D. O., Ching, C. K., Barrett, C., et al. (2009). Atrial fibrillation ablation strategies for paroxysmal patients: Randomized comparison between different techniques. Circulation: Arrhythmia and Electrophysiology, 2, 113–119.CrossRefGoogle Scholar
  4. 4.
    Kettering, K., Greil, G. F., Fenchel, M., Kramer, U., Weig, H. J., Busch, M., et al. (2009). Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach. Clinical Research in Cardiology, 98, 285–296.CrossRefPubMedGoogle Scholar
  5. 5.
    Willems S, Steven D, Servatius H, Hoffmann BA, Drewitz I, Müllerleile K, et al. (2010). Persistence of pulmonary vein isolation after robotic remote-navigated ablation for atrial fibrillation and its relation to clinical outcome. Journal of Cardiovascular Electrophysiology. doi: 10.1111/j.1540-8167.2010.01773.x.
  6. 6.
    Takahashi, Y., O’neill, M. D., Jönsson, A., Sanders, P., Sacher, F., Hocini, M., et al. (2006). How to interpret and identify pulmonary vein recordings with the lasso catheter. Heart Rhythm, 3, 748–750.CrossRefPubMedGoogle Scholar
  7. 7.
    Wright, M., Haïssaguerre, M., Knecht, S., Matsuo, S., O’Neill, M. D., Nault, I., et al. (2008). State of the art: Catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19, 583–592.CrossRefPubMedGoogle Scholar
  8. 8.
    Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S. A., Crijns, H. J., et al. (2007). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for personnel, policy, procedures and follow up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, 9, 335–379.CrossRefPubMedGoogle Scholar
  9. 9.
    Steinwender, C., Hönig, S., Leisch, F., & Hofmann, R. (2010). Clinical experience with routine use of a single combined mapping and ablation catheter for isolation of pulmonary veins in patients with paroxysmal atrial fibrillation. Wiener Klinische Wochenschrift, 122, 146–151.CrossRefPubMedGoogle Scholar
  10. 10.
    Luik, A., Merkel, M., Hoeren, D., Riexinger, T., Kieser, M., & Schmitt, C. (2010). Rationale and design of the FreezeAF trial: A randomized controlled noninferiority trial comparing isolation of the pulmonary veins with the cryoballoon catheter versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. American Heart Journal, 159, 555–560.CrossRefPubMedGoogle Scholar
  11. 11.
    Steinwender, C., Hönig, S., Leisch, F., & Hofmann, R. (2009). Acute results of pulmonary vein isolation in patients with paroxysmal atrial fibrillation using a single mesh catheter. Journal of Cardiovascular Electrophysiology, 20, 147–152.CrossRefPubMedGoogle Scholar
  12. 12.
    Kaseno, K., Tada, H., Koyama, K., Jingu, M., Hiramatsu, S., Yokokawa, M., et al. (2008). Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. The American Journal of Cardiology, 101, 1638–1642.CrossRefPubMedGoogle Scholar
  13. 13.
    Pratola, C., Baldo, E., Notarstefano, P., Toselli, T., & Ferrari, R. (2008). Radiofrequency ablation of atrial fibrillation: is the persistence of all intraprocedural targets necessary for long-term maintenance of sinus rhythm? Circulation, 117, 136–143.CrossRefPubMedGoogle Scholar
  14. 14.
    Neumann, T., Vogt, J., Schumacher, B., Dorszewski, A., Kuniss, M., Neuser, H., et al. (2008). Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. Journal of the American College of Cardiology, 52, 273–278.CrossRefPubMedGoogle Scholar
  15. 15.
    Neumann, T., Kuniss, M., Erkapic, D., Zaltsberg, S., Berkowitsch, A., Pajitnev, D., et al. (2010). Acute and long-term results of PVI at antrum using a novel high-density mapping catheter without help of 3D electro-anatomic mapping in patients with paroxysmal and chronic atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 27, 101–108.CrossRefPubMedGoogle Scholar
  16. 16.
    Arya, A., Piorkowski, C., Sommer, P., Kottkamp, H., & Hindricks, G. (2007). Clinical implications of various follow up strategies after catheter ablation of atrial fibrillation. Pacing and Clinical Electrophysiology, 30, 458–462.CrossRefPubMedGoogle Scholar
  17. 17.
    Steven, D., Rostock, T., Lutomsky, B., Klemm, H., Servatius, H., Drewitz, I., et al. (2008). What is the real atrial fibrillation burden after catheter ablation of atrial fibrillation? A prospective rhythm analysis in pacemaker patients with continuous atrial monitoring. European Heart Journal, 29, 1037–1042.CrossRefPubMedGoogle Scholar
  18. 18.
    Steinwender, C., Hönig, S., Leisch, F., & Hofmann, R. (2010). One-year follow-up after pulmonary vein isolation using a single mesh catheter in patients with paroxysmal atrial fibrillation. Heart Rhythm, 7, 333–339.CrossRefPubMedGoogle Scholar
  19. 19.
    Wijffels, M. C., Van Oosterhout, M., Boersma, L. V., Werneth, R., Kunis, C., Hu, B., et al. (2009). Characterization of in vitro and in vivo lesions made by a novel multichannel ablation generator and a circumlinear decapolar ablation catheter. Journal of Cardiovascular Electrophysiology, 20, 1142–1148.CrossRefPubMedGoogle Scholar
  20. 20.
    Mansour, M., Forleo, G. B., Pappalardo, A., Heist, E. K., Avella, A., Laurenzi, F., et al. (2008). Initial experience with the mesh catheter for pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Heart Rhythm, 5, 1510–1516.CrossRefPubMedGoogle Scholar
  21. 21.
    Mesas, C. E., Augello, G., Lang, C. C., Gugliotta, F., Vicedomini, G., Sora, N., et al. (2006). Electroanatomic remodeling of the left atrium in patients undergoing repeat pulmonary vein ablation: Mechanistic insights and implications for ablation. Journal of Cardiovascular Electrophysiology, 17, 1279–1285.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Robert Hofmann
    • 1
    Email author
  • Simon Hönig
    • 1
  • Franz Leisch
    • 1
  • Clemens Steinwender
    • 1
  1. 1.Cardiovascular DivisionCity Hospital LinzLinzAustria

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