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Vallès E, Benito B, Jiménez J, Cabrera S, Alcalde O, Altaba C, Guijo MA, Fan R, Martí-Almor J. Double factor single shot to diminish complications in cryoballoon ablation procedures for atrial fibrillation. J Interv Card Electrophysiol 2018; 55:17-26. [PMID: 30411175 DOI: 10.1007/s10840-018-0483-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/30/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Cryoballoon ablation (CBA) has become a standard treatment for recurrent atrial fibrillation (AF). There is need for improved CBA protocols. We aimed to demonstrate that a new protocol including minimum temperature (minT) reached could reduce procedure times and complications. METHODS A new double factor protocol (DFP), based on the performance of one single shot per vein with variable duration, and conditional bonus shot, determined by time-to-effect (TTE) and minT, was compared with the conventional protocol (CP), with at least two shots per vein. Procedure parameters, complications, and efficacy were compared. RESULTS We prospectively included 88 consecutive patients treated with the DFP. These were compared to the previous consecutive 69 patients treated with CP. All procedures were performed with 28-mm second-generation balloon. Acute pulmonary vein (PV) isolation was similar (98.6% vs. 98.9% in CP vs. DFP, p = 0.687). Procedure and ablation times favored DFP over CP (120 vs. 134 min, p = 0.003; and 1051 vs. 1475 s, p < 0.001; respectively). A composite of major and minor complications was significantly reduced in the DFP compared to the CP (18.8% vs. 6.8%, p = 0.02; respectively). Within a follow-up of 18 months, freedom from AF was 79.7% in CP and 78.4% in DFP (Log-rank 0.501). Paroxysmal AF and absence of PV potentials predicted better arrhythmia outcomes (HR 2.14 for paroxysmal vs. persistent, p = 0.031; and HR 1.61 for absence vs. presence of PV potentials, p = 0.01). CONCLUSIONS The novel DFP results in reduced complication rates and procedure times, with similar success rates compared with a conventional strategy.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain. .,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Begoña Benito
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jesús Jiménez
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carmen Altaba
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Miguel Angel Guijo
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine Health Science Center, T16-80, Stony Brook, NY, 11794, USA
| | - Julio Martí-Almor
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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