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Outcome of paroxysmal atrial fibrillation ablation with the cryoballoon using two different application times: the 4- versus 3-min protocol

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Abstract

Purpose

The second-generation cryoballoon (CBG2) is highly effective for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). One-year outcome data are consistent among different research groups. First results suggest that a shortened application time might be equally effective. The objective of the study was to compare procedural and outcome data for a 240 and 180-s protocol.

Methods

Prospectively, consecutive patients with symptomatic PAF underwent initial PVI with CBG2. In succession, two groups were created: the application time was 240 s in group 1 and 180 s in group 2. In both groups, a bonus application was applied. Periprocedural data, complications, and freedom from atrial fibrillation (AF)/AT/symptoms were compared between the groups.

Results

From May 2012 to June 2013, 114 patients (57 per group, 38 % female) were included. The mean left atrial dwelling time decreased by 19 min (−16 %) in group 2 compared to group 1 (p = 0.005). Intraprocedural pulmonary vein (PV) reconduction occurred infrequently (0.4 % in both groups, p = 1.0). One persistent PNP occurred and resolved during the follow-up. Complications were without significant differences. One patient was lost to follow-up. The cumulative rates of freedom from recurrence at 12 months are 76.8 % in group 1 and 83.6 % in group 2. After a mean follow-up of 491 ± 208 days, the rates of freedom from AF/AT/symptoms at last visit were 38/57 (67 %) and 44/56 (78.6 %) in groups 1 and 2 (p = 0.14), respectively. Female sex was identified as a predictor for recurrence.

Conclusions

Compared to a protocol with cryoballoon applications of 240 s, a shortened application time to 180 s results in a faster procedure with comparable high rates of freedom from AF at 16 months. Female sex seems to be predictive for recurrences; this finding has to be reconfirmed in a larger population.

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Abbreviations

AF:

Atrial fibrillation

CB:

Cryoballoon

CBG2:

Second-generation cryoballoon

LA:

Left atrium

PAF:

Paroxysmal atrial fibrillation

PNP:

Phrenic nerve palsy

PV:

Pulmonary vein

PVI:

PV isolation

RF:

Radiofrequency

SD:

Standard deviation

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Acknowledgments

The authors are grateful to June Tomelden-Pade for helping with data acquisition and Armin Schwarz for assisting with the statistics and graphical design. Special thanks goes to our EP team supporting our work with a high degree of flexibility when introducing new technology or protocols to our lab.

Author contributions

All authors made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted: Dr. F. Straube performed the analysis and interpretation of the data, drafted the manuscript and is the corresponding author. Drs. F. Straube, Dorwarth, Bunz, Hartl and Wankerl were involved in data acquisition, patient recruitment, and revised the manuscript. Dr. Ebersberger performed the LA/PV imaging prior to the procedure including the data acquisition and critically revised the manuscript. Dr. Hoffmann was responsible for the concept of the study, supported the scientific activities as the head of the department, and revised and approved the manuscript.

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Authors and Affiliations

  1. Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Englschalkinger Str. 77, 81925, Munich, Germany

    Florian Straube, Uwe Dorwarth, Stefan Hartl, Benedikt Bunz, Michael Wankerl, Ullrich Ebersberger & Ellen Hoffmann

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  1. Florian Straube
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Correspondence to Florian Straube.

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Conflict of interest

Dr. Straube received honoraria for lectures/travel expenses from Medtronic, Biotronik, Boehringer Ingelheim and Bristol-Myers-Squibb/Pfizer. Dr. Dorwarth received honoraria for lectures/travel expenses from Medtronic. Drs. Wankerl, Ebersberger: none. Drs. Bunz, Hartl received travel support from Medtronic. Dr. Hoffmann received honoraria for lectures from Boehringer Ingelheim, Boston Scientific, MSD SHARP&DOHME GmbH, and research funding from Biotronik, Edwards Corp, Medtronic, Philips, St. Jude Medical, Braun AG and Stentys Inc.

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Straube, F., Dorwarth, U., Hartl, S. et al. Outcome of paroxysmal atrial fibrillation ablation with the cryoballoon using two different application times: the 4- versus 3-min protocol. J Interv Card Electrophysiol 45, 169–177 (2016). https://doi.org/10.1007/s10840-015-0084-3

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