A 51-year-old Caucasian male with hypertension was admitted to our hospital for ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drugs.
After a single trans-septal puncture, the left atrium (LA) imaging was performed using a decapolar circular mapping catheter (Achieve Advance 25, Medtronic) and KODEX-EPD (EPD Solutions, a Philips company) system. During LA reconstruction, a LCPV was rapidly identified (Fig. 1). Achieve was placed within the LCPV, the cryoballoon (Arctic Front Advance Pro, 28 mm diameter, Medtronic) was inflated, and baseline occlusion tool software data were collected. Then, cryoballoon was positioned, occlusion was verified by occlusion tool software tool [KODEX-EPD (EPD Solutions, a Philips company)], and PV angiography was performed showing the complete occlusion of LCPV (Fig. 2). Cryoenergy was delivered reaching the following parameters: time to isolation was 26 s, and max temperature was − 53 °C with a freeze-cycle duration of 180 s. Achieve was positioned into every single branch of LCPV to check the complete electrical isolation. As previously described [5], a single cryoenergy delivery was useful for complete isolation of a long and tight LCPV (Fig. 3). Similarly, right superior PV (RSPV) and right inferior PV (RIPV) were isolated using occlusion tool software tool information.