Adding Non-Occlusive Cryoballoon Ablation in Case of Ostial-Level Pulmonary Vein Isolation or Carina Sparing Does Not Improve 1-Year Outcome After Cryoballoon Ablation (the NOCA-AF Study).

Strazdas, A; Tijskens, M; Abugattas, Juan Pablo; Wolf, M; Schwagten, B; De Greef, Ysaline

doi:10.1111/jce.70011

Adding Non-Occlusive Cryoballoon Ablation in Case of Ostial-Level Pulmonary Vein Isolation or Carina Sparing Does Not Improve 1-Year Outcome After Cryoballoon Ablation (the NOCA-AF Study).

Strazdas, A

;

Tijskens, M

;

Abugattas, Juan Pablo

;

Wolf, M

;

De Greef, Ysaline

;et.al.

(2025) Journal of Cardiovascular Electrophysiology — Vol. 36, n° 9, p. 2330-2340 (2025)

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Authors

Strazdas, A
Author
Tijskens, M
Author
Abugattas, Juan PabloUCLouvain
Author
Wolf, M
Author
De Greef, YsalineUCLouvain
Author

Abstract

Fixed-diameter cryoballoon ablation (CBA) can yield suboptimal ostial-level pulmonary vein isolation (PVI) and spare arrhythmogenic sites like the carina. The addition of non-occlusive cryoballoon ablation (NOCA) could overcome this limitation of CBA. We aimed to assess the need and effectiveness of NOCA and its impact on clinical outcomes. One hundred AF patients (66 ± 10 years, 40 females) were prospectively randomized to CBA (Control group, n = 50) or CBA + NOCA if needed (Study group, n = 50). Ostial-level PVI and carina sparing was assessed by electroanatomic left atrial (LA) voltage mapping after CBA. Endpoint was documented AF/AFL/AT ( > 30 s) at 12 months, with Holters at 6 and 12 months. After CBA, ostial PVI level was seen in 110 out of 392 veins (28%), with predominance of the left superior PV and carina sparing in 11 (11%) left PVs and 16 (16%) right PVs. Overall, voltage mapping displayed a potential NOCA need in 68 (68%) patients. Spatially, for both PV sides, preferential ostial-level PVI segments were situated at the posterior wall. NOCA was added in 38 (76%) study patients, confirmed effective in all by voltage remapping. At 1 year, AF/AFL/AT recurrence occurred in 12 (24%) Study and 6 (12%) control patients (p = 0.121). Ostial-level PVI and carina sparing occurs in a substantial amount of patients treated by CBA. Although NOCA proved effective in extending the lesion size to antral-level PVI or carina ablation, adding NOCA did not improve 1-year clinical outcome.

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Strazdas, A., Tijskens, M., Abugattas, J. P., Wolf, M., Schwagten, B., & De Greef, Y. (2025). Adding Non-Occlusive Cryoballoon Ablation in Case of Ostial-Level Pulmonary Vein Isolation or Carina Sparing Does Not Improve 1-Year Outcome After Cryoballoon Ablation (the NOCA-AF Study). Journal of Cardiovascular Electrophysiology, 36(9), 2330-2340. https://doi.org/10.1111/jce.70011 (Original work published 2025)