Abstract | OBJECTIVES: This study sought to evaluate the durability of pulmonary vein isolation (PVI) after 2 different freeze durations by using time-to-effect guided ( ICE-T) second generation cryoballoon (CB2) ablation strategy in patients with atrial fibrillation (AF) undergoing repeat procedure. BACKGROUND: CB2 represents a powerful technology for PVI. Recently, the ICE-T CB2 ablation strategy targeting a 240-s single freeze demonstrated fast and efficient PVI. To further optimize safety and efficacy, a shortened 3-min freeze duration has been suggested, but PVI durability remains unclear. METHODS: Between May 1, 2013 and December 31, 2017, all CB2 ablations followed the ICE-T concept (target freeze: 240 s or 180 s). Patients undergoing a second procedure for arrhythmia recurrence were analyzed. Two groups were defined based on the index freeze duration (group A: 240 s vs. group B: 180 s). In all repeat procedures a 3-dimensional left-atrial map was obtained. Durability of PVI and localization of conduction gaps were compared. RESULTS: Of 788 total patients, 106 (13%) underwent a second procedure (group A: 80 of 604 vs. group B: 26 of 184) after a mean of 377 days. There was no difference regarding PV occlusion and time-to-isolation in the index procedure between the 2 groups. No major complications occurred. During the second procedure, significantly more patients demonstrated durable isolation of all PV in group A (61% vs. 35%; p = 0.02) along with a significantly increased rate of PVI durability (88% vs. 69%, per vein; p < 0.001). Left-sided PV did significantly benefit from 240-s freeze (reconnection left superior PV: 6% vs. 27%; p = 0.004, left inferior PV: 14% vs. 39%; p = 0.006). CONCLUSIONS: The ICE-T ablation strategy is associated with a high rate of durable PVI in patients with arrhythmia recurrence. Target freeze duration of 240 s versus 180 s is associated with significantly increased lesion durability, particularly at left-sided PV, without increasing complications.
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Authors | Shaojie Chen, Boris Schmidt, Stefano Bordignon, Laura Perrotta, Fabrizio Bologna, K R Julian Chun |
Journal | JACC. Clinical electrophysiology
(JACC Clin Electrophysiol)
Vol. 5
Issue 5
Pg. 551-559
(05 2019)
ISSN: 2405-5018 [Electronic] United States |
PMID | 31122376
(Publication Type: Journal Article)
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Copyright | Copyright © 2019. Published by Elsevier Inc. |
Topics |
- Aged
- Atrial Fibrillation
(surgery)
- Catheter Ablation
(adverse effects, methods, statistics & numerical data)
- Cryosurgery
(adverse effects, methods, statistics & numerical data)
- Female
- Humans
- Male
- Middle Aged
- Pulmonary Veins
(surgery)
- Retrospective Studies
- Treatment Outcome
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