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Shorter RSPV cryoapplications result in less phrenic nerve injury and similar 1‐year freedom from atrial fibrillation
Author(s) -
Molenaar Marleen M.D.,
Hesselink Tim,
ter Bekke Rachel M.A.,
Scholten Marcoen F.,
Manusama Randy,
Pison Laurent,
BrusseKeizer Marjolein,
Kraaier Karin,
ten Haken Bernard,
Grandjean Jan G.,
Timmermans Carl C.,
Opstal Jurren M.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14062
Subject(s) - medicine , pulmonary vein , atrial fibrillation , paroxysmal atrial fibrillation , cardiology , randomized controlled trial , anesthesia , surgery
Background In the 123‐study, we prospectively assessed, in a randomized fashion, the minimal cryoballoon application time necessary to achieve pulmonary vein (PV) isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) with the aim to reduce complications by shortening the application duration. The first results of this study demonstrated that shortened cryoballoon applications (<2 minutes) resulted in less phrenic nerve injury (PNI) without compromising acute isolation efficacy for the right PVs. We now report the 1‐year follow‐up results regarding safety and efficacy of shorter cryoballoon applications. Methods A total of 222 patients with AF were randomized to two applications of 1 min “short,” 2 min “medium,” or 3 min “long” duration, 74 per group. Recurrence of AF and PV reconduction at 1‐year follow‐up were assessed. Results The overall 1‐year freedom from AF was 79% and did not differ significantly between the short, medium, and long application groups (77%, 74%, and 85% for short, medium, and long application groups, respectively; P = 0.07). In 30 patients, a redo PVI procedure was performed. For all four PVs, there was no significant difference in reconduction between the three groups. Reconduction was most common in the left superior PV (57%). The right superior PV (RSPV) showed significantly less reconduction (17%) compared to the other PVs. Conclusions Shortening cryoballoon applications of the RSPV to <2 minutes results in less PNI, while acute success and 1‐year freedom from AF are not compromised. Therefore, shorter cryoballoon applications (especially) in the RSPV could be used to reduce PNI.