Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation ― Impact of Different Ablation Strategies ―
Open Access
- 25 May 2020
- journal article
- research article
- Published by Japanese Circulation Society in Circulation Journal
- Vol. 84 (6), 902-910
- https://doi.org/10.1253/circj.cj-19-1144
Abstract
Background:The second-generation cryoballoon (CB2) has demonstrated high procedural efficacy and convincing clinical success rates for pulmonary vein isolation (PVI). Nevertheless, data on the impact of different ablations protocols on durability are limited. The aim was to comparing the durability of PVI following 3 different ablation strategies in patients with recurrence of atrial fibrillation or atrial tachycardia undergoing repeat procedures. Methods and Results:In 192 patients, a total of 751 PVs were identified. All PVs were successfully isolated during index PVI. Thirty-one out of 192 (16%) patients were treated with a bonus-freeze protocol (group 1), 67/192 (35%) patients with a no bonus-freeze protocol (group 2), and 94/192 (49%) patients with a time-to-effect-guided protocol (group 3). Persistent PVI was documented in 419/751 (55.8%) PVs, and in 41/192 (21%) patients, all PVs were persistently isolated. The total rate of PV reconnection was not significantly different between the groups (P=0.134) and the comparison of individual PVs revealed no differences (P-values for RSPV: 0.424, RIPV: 0.541, LSPV: 0.788, LIPV: 0.346, LCPV: 0.865). The procedure times were significantly reduced by omitting the bonus-freeze and applying individualized application times (group 1: 123.4±31.5 min, group 2: 112.9±39.8 min, group 3: 86.67±28.4 min, PConclusions:Comparing 3 common ablation protocols, no differences for durable PVI were detected. Procedure times were significantly reduced by omitting the bonus-freeze cycle and by applying individualized application times.Keywords
This publication has 20 references indexed in Scilit:
- Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial FibrillationThe New England Journal of Medicine, 2016
- Bonus-freeze: benefit or risk? Two-year outcome and procedural comparison of a "bonus-freeze" and "no bonus-freeze" protocol using the second-generation cryoballoon for pulmonary vein isolation.Clinical Research in Cardiology, 2016
- Once Isolated, Always Isolated?Circulation: Arrhythmia and Electrophysiology, 2015
- Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) StudyJournal of Cardiovascular Electrophysiology, 2015
- One-year clinical success of a ‘no-bonus’ freeze protocol using the second-generation 28 mm cryoballoon for pulmonary vein isolationEP Europace, 2015
- Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolationHeart Rhythm, 2015
- Reduced incidence of esophageal lesions by luminal esophageal temperature–guided second-generation cryoballoon ablationHeart Rhythm, 2015
- High rate of durable pulmonary vein isolation after second-generation cryoballoon ablation: analysis of repeat proceduresEP Europace, 2015
- One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm CryoballoonCirculation: Arrhythmia and Electrophysiology, 2014
- Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm CryoballoonCirculation: Arrhythmia and Electrophysiology, 2013