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Cryoballoon pulmonary vein isolation in treating atrial fibrillation using different freeze protocols: The “ICE‐T 4 minutes vs 3 minutes” propensity‐matched study (Frankfurt ICE‐T 4 vs. 3)
Author(s) -
Chen Shaojie,
Schmidt Boris,
Bordig Stefano,
Tohoku Shota,
Urbanek Lukas,
Plank Karin,
Willems Franziska,
Throm Christina,
Konstantinou Athanasios,
Hilbert Max,
Zanchi Simone,
Bianchini Lorenzo,
Bologna Fabrizio,
Tsianakas Nikolaos,
Kreuzer Claudia,
Nagase Takahiko,
Perrotta Laura,
Last Jana,
Chun K. R. Julian
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14602
Subject(s) - medicine , pulmonary vein , atrial fibrillation , propensity score matching , ablation , cardiology , anesthesia , adverse effect , catheter ablation , surgery
Background Time‐to‐isolation (TTI) guided second‐generation cryoballoon (CB2) ablation has been shown to be effective for pulmonary vein isolation (PVI). Objective The objective of this paper is to compare the safety and clinical outcome of CB2 PVI using the TTI guided 4 minutes vs 3 minutes freeze protocol. Methods This was a propensity‐matched study based on an institutional database. Symptomatic atrial fibrillation (AF) patients who underwent CB2 PVI and systematic follow‐up were consecutively included. Results A total of 573 patients were identified, of them 214 (107 matched‐pairs) symptomatic AF (paroxysmal AF: 61%, persistent AF: 39%) patients (age: 67.7 ± 11.2 years) were analyzed. The baseline characteristics were comparable between the two groups. Procedural time was significantly longer in the 4 minutes group compared to 3 minutes group (67.2 ± 21.8 vs 55.9 ± 16.9 minutes, P < .0001). During a mean follow‐up of 2 years, the 4 minutes group was associated with a significantly higher rate of freedom from arrhythmia recurrence compared with the 3 minutes group (66.4% vs 56.1%, P = .009), which was mainly driven by patients with persistent AF. The multivariate regression showed that the 4 minutes freeze was the independent predictor of freedom from arrhythmia recurrence. During the repeat procedure, the 4 minutes group was associated with a significantly higher rate of durable PVI. There was no difference regarding procedural adverse events between the two groups. Conclusion As compared with the 3 minutes freeze, the TTI guided 4 minutes freeze is associated with a significantly higher rate of arrhythmia‐free and durable PVI without compromising the safety profile, patients with persistent AF may benefit from the TTI guided 4 minutes freeze more pronouncedly.