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Heart, Lung and Circulation

New Minimally Invasive and Tailor-Made Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation

Published:November 06, 2021DOI:https://doi.org/10.1016/j.hlc.2021.10.003

      Background

      The optimal dosage for cryoballoon ablation (CBA) of atrial fibrillation (AF) is still unknown.

      Objective

      This study aimed to evaluate the clinical implications of a reduction in the freezing duration to <180 seconds during CBA guided by the time to the target temperature.

      Methods

      This study enrolled 325 consecutive paroxysmal AF patients who underwent CBA. It was a retrospective observational study in a single centre. It compared 164 patients who underwent a tailor-made CBA procedure (group T) with 161 who had a standard CBA procedure (group S). In group T, the freezing duration was reduced to 150 seconds when the temperature reached ≤ –40 °C within 40 seconds. Furthermore, it was reduced to 120 seconds when it reached ≤ –50 °C within 60 seconds. In the other patients, the freezing duration was 180 seconds, except for excessive freezing of ≤ –60 °C and/or emergent situations while monitoring the oesophageal temperature, and for phrenic nerve injury, as in group S.

      Results

      In group T, 89 patients (83%) underwent CBA with a reduction in the freezing duration. The total freezing time for each pulmonary vein was significantly shorter in group T than group S, and the total procedure time in group T decreased by an average of 4 minutes compared with group S. The rate of requiring additional radio frequency ablation following the CBA was significantly lower in group T than group S. The AF-free survival rate during the follow-up period (median, 366 days) was similar between the two groups.

      Conclusion

      The safety and efficacy of the new CBA strategy were non-inferior to the standard procedure.

      Keywords

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      Linked Article

      • Tailored Cryoballoon Pulmonary Vein Ablation for Atrial Fibrillation: When to Stop the Freeze?
        Heart, Lung and CirculationVol. 31Issue 4
        • Preview
          Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increasing prevalence and burden on the health care system [1,2]. Recently, comprehensive lifestyle and risk factor modification have been shown to reduce AF burden but there has been no new anti-arrhythmic drug discovery for many years [3]. Catheter ablation remains an attractive strategy to combat AF in patients with symptomatic AF despite lifestyle and pharmacological therapy. Although our understanding of the pathophysiological mechanisms underlying AF has improved, pulmonary vein isolation (PVI) remains the gold standard in catheter-based therapy for this complex arrhythmia as recent research aimed at targeting putative AF drivers has not shown significant incremental improvement in achieveing freedom from AF [4].
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