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\begin{document}

\title{Improved real-time recordings using the fourth generation cryoballoon
technology -- detection of dual fascicle electrograms}



\author[1]{Vedran Velagić}%
\author[2]{Giacomo Mugnai}%
\author[1]{Vedran Pasara}%
\author[1]{Ivan Prepolec}%
\author[1]{Mislav Puljevic}%
\author[1]{Borka Pezo-Nikolic}%
\author[1]{Davor Puljevic}%
\author[1]{Jure Samardzic}%
\author[1]{Maja Cikes}%
\author[1]{Davor Milicic}%
\affil[1]{University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia}%
\affil[2]{Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy}%


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  \date{May 04, 2024}


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\begin{abstract}
Introduction: We aimed to analyze the rate of visualization of real-time
(RT) recordings and dual fascicle electrograms in our first series of
patients treated with the fourth generation cryoballoon (CB) device.
Methods: All consecutive patients who underwent CB ablation using the
fourth generation technology were included in the analysis. In all
procedures we used a 28 mm CB placed via a single transseptal puncture
guided by intracardiac ultrasound. A 20 mm octapolar intraluminal
circular catheter was used for intracranial recordings. A single 180
seconds freeze strategy was employed. Results: A total of 123 patients
(72.9\% male, mean age 60.1\selectlanguage{ngerman}±10.9 years) were enrolled in the study. RT
recordings were detected in 445 (86.2\%) pulmonary veins (PVs).
Specifically, RT recordings were visualized in 115 left superior PVs
(89.2\%), 107 left inferior PVs (82.9\%), 118 right superior PVs
(91.4\%) and 105 right inferior PVs (81.3\%). Furthermore, in 23 of 516
PVs (4.4\%), two fascicle electrograms were detected. Dual fascicles
were most commonly observed in left superior PV (6.2\%). In both
inferior PVs dual fascicles were observed in 4.6\% while this phenomenon
was least frequent in right superior PV (2.3\%). Conclusion: By using
the fourth-generation CB we report a specific pattern of isolation
represented by a sequential isolation of two apparently distinct PV
fascicles during a single CB freeze delivery. This phenomenon occurred
in 4.4\% of PV ablations. Of note, the rate of visualization of RT
isolation with this novel CB was very high and could be documented in
86.2\% of PVs.%
\end{abstract}\selectlanguage{ngerman}%



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\verb`fascikli pejper rev 5.doc`  available at \url{https://authorea.com/users/310036/articles/440870-improved-real-time-recordings-using-the-fourth-generation-cryoballoon-technology-detection-of-dual-fascicle-electrograms}

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