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Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow-up after pulmonary vein isolation.

AbstractBACKGROUND:
The second-generation cryoballoon (CB-Adv) is effective in achieving pulmonary vein isolation (PVI) with encouraging results. The mid-term clinical efficacy of a single 3-minute freeze, without a routine bonus application, has been recently demonstrated.
OBJECTIVE:
The purpose of this study was to assess long-term clinical outcome after PVI with the CB-Adv using a single 3-minute application.
METHODS:
A total of 143 consecutive patients (93 male [65%], mean age 59.6 ± 12.0 years) with paroxysmal atrial fibrillation (PAF; 113/143 [79%]) or early persistent atrial fibrillation (AF; 30/143 [21%]) underwent PVI using CB-Adv with a single 3-minute freeze. Atrial tachyarrhythmia recurrences were defined as symptomatic or documented episodes >30 seconds.
RESULTS:
After a single freeze, isolation could be reached in 94.1% of all identified pulmonary veins. Complete PVI was successfully achieved with 1.1 ± 0.4 mean freezes. Persistent phrenic nerve palsy occurred in 5 of 143 patients (3.5%). At a mean 12.1 ± 4.4 months of follow-up, after a 3-month blanking period (BP), 80.4% (115/143) were in stable sinus rhythm (93/113 [82.3%] for PAF; 22/30 [73.3%] for early persistent AF). Fifteen patients underwent a second procedure with radiofrequency ablation showing reconnection in 7 of 15 right-sided (46.7%) and 6 of 15 left-sided (40%) pulmonary veins. Relapses during BP (P <.01), time to PVI (P = .02), and longer AF duration (P = .04) were independent predictors of recurrences.
CONCLUSION:
A single 3-minute freeze is highly effective, determining an atrial tachyarrhythmia freedom of 80.4% at 1-year follow-up. The incidence of persistent phrenic nerve palsy is 3.5%. Relapses during BP, time to PVI, and longer AF duration are predictors of recurrences. Routine use of an "insurance freeze" may not be needed.
AuthorsGiuseppe Ciconte, Carlo de Asmundis, Juan Sieira, Giulio Conte, Giacomo Di Giovanni, Giacomo Mugnai, Yukio Saitoh, Giannis Baltogiannis, Ghazala Irfan, Hugo Enrique Coutiño-Moreno, Burak Hunuk, Vedran Velagić, Pedro Brugada, Gian-Battista Chierchia
JournalHeart rhythm (Heart Rhythm) Vol. 12 Issue 4 Pg. 673-80 (Apr 2015) ISSN: 1556-3871 [Electronic] United States
PMID25542427 (Publication Type: Journal Article)
CopyrightCopyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Topics
  • Aged
  • Atrial Fibrillation (diagnosis, surgery)
  • Catheter Ablation (instrumentation)
  • Cryosurgery (instrumentation)
  • Electrocardiography
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Postoperative Complications (diagnosis, surgery)
  • Pulmonary Veins (surgery)
  • Recurrence
  • Reoperation
  • Time Factors
  • Treatment Outcome

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