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Introduction: In cryoballoon ablation (CBA) procedures, transseptal access (TSA) is generally achieved using a standard sheath and needle system that is exchanged for the cryoballoon delivery sheath and dilator over a long wire. Sheath exchange has been related with air embolic events. Recently, an integrated dilator‐needle system assembled to the cryoballoon sheath was introduced. We aimed to evaluate the efficacy and safety of an integrated TSA tool compared with the traditional approach in atrial fibrillation CBA procedures. Methods: Patients scheduled for CBA procedures were randomized 1:1 to traditional TSA (t‐TSA) or integrated TSA (i‐TSA). TSA time was defined as time from superior vena cava to LA insertion of the cryoballoon delivery sheath, after sheath exchange (t‐TSA) or directly (i‐TSA). Results: Ninety‐seven patients (76 males, mean age 59 ± 10 years) were randomized, 48 patients underwent t‐TSA, and 49 i‐TSA. Mean TSA time was 5 min 59 s ± 5 min 36 s in the t‐TSA group and 2 min 59 s ± 2 min 14 s in the i‐TSA group (p <.001). Total fluoroscopy time, skin‐to‐skin procedure time, and LA dwell time were respectively 15 ± 6, 69 ± 16, and 44 ± 12 min in the t‐TSA group and 13 ± 6, 65 ± 15, and 43 ± 11 min in the i‐TSA group (p = ns). No clinically significant acute complications related to TSA were noted in both cohorts. Conclusion: This is the first randomized study comparing both TSA approaches. TSA in CBA procedures using this integrated tool enables a safe and efficient workflow, reducing TSA time and avoiding sheath exchange. [ABSTRACT FROM AUTHOR]

Background: Superior vena cava (SVC) isolation with radiofrequency energy remains a challenge due to potential side effects, especially phrenic nerve (PN) or sinus node injury. The purpose of this study was to evaluate the feasibility of a novel SVC isolation technique using the third‐generation cryoballoon (CB3). Methods: Patients undergoing atrial fibrillation (AF) ablation were prospectively included. The procedure was performed with the CB3, beginning with the pulmonary veins and ending with SVC isolation. During applications in the SVC, continuous PN capture and sinus rate were monitored. Once reached SVC isolation during the application, 60 s more was applied, with no bonus application. If after 90 s the SVC was not isolated, application was stopped. A maximum number of four applications were permitted. Results: Thirty patients (62 ± 9 years; 74% male, 78% paroxysmal AF) were included. No SVC activity was observed in two patients. Success rate for SVC isolation was 89%. Mean number of applications per patient was 2.3 ± 1. Mean time to SVC isolation was 37 ± 20 s. Mean duration of application was 92 ± 15 s. Mean total time of procedure for SVC isolation was 218 ± 43 s. We recorded only two complications: one transient PN palsy and one short and transient sinus arrest. After a mean follow‐up of 5 ± 2 months, 89% are free from arrhythmia recurrence. Conclusions: We present a promising simple SVC‐isolation technique using CB3, featuring a high success rate and very low incidence of complications. [ABSTRACT FROM AUTHOR]