The Need for Repeat Ablation Following Pulmonary Vein Isolation With Both the First and Second Generation Arctic Front Cryoballoon: A Single Center Analysis Matt Brunson, MD, Kevin R. Wheelan, MD, Robert C. Kowal, MD/PhD, Alan Donsky, MD, Jay Franklin, MD, Cathy Headley, RN, David Michaels, B.A., Naveed Sarmast, MPH Introduction Methods Results • PVI using the first generation cryoballoon catheter(CB-Gen1) has been proven to be effective for patients with symptomatic paroxysmal atrial fibrillation.  Single center, retrospective analysis. • The second generation cryoballoon catheter(CB-Gen2) has been developed providing more uniform cooling over the balloon surface area, thereby theoretically improving the efficacy of PVI.  The first 303 cases were performed with CBGen1. The next 239 cases were performed with CB-Gen2. Objectives  542 consecutive patients with drug-refractory paroxysmal or early persistent AF underwent their first PVI with a cryoballoon catheter.  The mean follow-up time was 271 days for CB-Gen1 and 264 days for CB-Gen2. Pulmonary Vein Reconnection  Of the 303 patients treated with CBGen1, 18 (6%) underwent repeat ablation within the follow up period, and 16 (89%) of these had pulmonary vein reconnection. Of the 239 patients treated with CB-Gen2, 5 (2%) underwent repeat ablation within the follow up period, and 3 (60%) of these had pulmonary vein reconnection.  Unadjusted analysis demonstrates a significantly lower voluntary rate of repeat AF ablation procedures when CBGen2 was used for the index PVI compared with CB-Gen1 (unadjusted Relative Risk=2.83; 95%CI: 1.06, 7.53). Isolated Pulmonary Veins LUPV LLPV RUPV RLPV Reconnected Pulmonary Veins LUPV LLPV Methods - Clinical Endpoint Repeat Ablations  1) To determine the need for repeat ablation for recurrent symptomatic atrial fibrillation (AF) after pulmonary vein isolation (PVI) with CB-Gen1 vs CBGen2.  2) To determine the incidence of pulmonary vein reconnection (PVR) at the time of repeat ablation for recurrent AF.  1) The number of repeat ablations performed due to recurrent symptomatic AF.  2) The incidence of PVR at repeat ablation.  Repeat procedures were performed at the discretion of each patient and their physician. Catheter Number of Mean Incidence of Cases Follow-up Repeat Ablation CB-Gen1 303 271 days 6% (18 pt’s) CB-Gen2 239 264 days 2% (5 pt’s) Catheter Incidence of Pulmonary Vein Reconnection at Repeat Ablation CB-Gen1 89% (16 pt’s) CB-Gen 60% (3 pt’s) Conclusions  In our single center analysis, the use of CB-Gen2 was associated with a lower incidence of repeat ablation for AF among patients undergoing cryoballoon-based PVI. Disclosures M. Brunson: None. K.R. Wheelan: Speakers Bureau, Significant, Medtronic; Ownership Interest, Significant, Medtronic; Consultant/Advisory Board, Significant, Medtronic. R.C. Kowal: Consultant/Advisory Board, Significant, Medtronic. J Franklin: Medtronic Speakers Bureau. Alan Donsky: None. C Headley: None. D Michaels: None. N Sarmast: None