Author + information
- Received December 6, 2018
- Revision received March 26, 2019
- Accepted March 26, 2019
- Published online May 20, 2019.
- Shaojie Chen, MD, PhD∗ (, )
- Boris Schmidt, MD∗ (, )
- Stefano Bordignon, MD,
- Laura Perrotta, MD,
- Fabrizio Bologna, MD and
- K.R. Julian Chun, MD∗ ()
- Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
- ↵∗Address for correspondence:
Dr. Shaojie Chen, Dr. Boris Schmidt, OR Dr. K. R. Julian Chun, Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Strasse 4, 60431 Frankfurt am Main, Germany.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page
- Received December 6, 2018.
- Revision received March 26, 2019.
- Accepted March 26, 2019.
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