Improved 1-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation.

BACKGROUND: The second-generation cryoballoon (CB2) has recently been introduced featuring improved surface cooling. Increased procedural efficacy of pulmonary vein isolation (PVI) when compared to the first-generation balloon (CB1) has been reported. The aim of the study was to investigate the clinical outcome of cryoballoon PVI after 1 year using the CB2 as compared to the CB1. METHODS AND RESULTS: A total of 105 consecutive patients with paroxysmal atrial fibrillation (AF) were studied. Cryoballoon PVI (28 mm) was performed in 50 patients using the CB1, and in 55 patients using the CB2. Patients were scheduled for 72-hour Holter ECG recording at 3, 6, 9, and 12 months and every 6 months thereafter. The study endpoint was defined as recurrent AF or atrial tachycardia >30 seconds documented after a blanking period of 90 days after the procedure. Complete PVI was achieved in 49/50 (98%) and 55/55 (100%) patients in the CB1 and CB2 group, respectively. After a mean follow-up of 416 ± 75 days, 21 (CB1 group) and 10 (CB2 group) patients reached the study endpoint. Kaplan-Meier estimates of arrhythmia-free survival after a single procedure without AAD therapy after 1 year were 63.9% versus 83.6% (P = 0.008) in the CB1 and CB2 group, respectively. Persistent phrenic nerve palsy with delayed healing occurred in 2 (CB1 group) and 3 (CB2 group) patients. CONCLUSION: Clinical outcome of PVI using the CB2 was significantly improved when compared to the CB1.

The Palatal Closure Efficiency (PaCE) Index: A New Speaker-Centered Aerodynamic Metric for the Evaluation of Velopharyngeal Function During Speech.

PURPOSE: Pressure-flow testing provides clinicians with estimates of velopharyngeal (VP) gap size during speech production. Traditionally, adequacy of VP function has been based on absolute area criteria. This clinical focus article provides a brief overview of pressure-flow testing and introduces the PaCE index, a speaker-centered metric to interpret findings. CONCLUSION: The PaCE index provides information on a speaker's ability to achieve VP closure during oral plosives relative to his/her own VP opening during a nasal consonant. This approach provides both clinicians and patients with more meaningful information to interpret pressure-flow findings for both diagnostic and treatment outcome purposes.