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Double factor single shot to diminish complications in cryoballoon ablation procedures for atrial fibrillation

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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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Authors and Affiliations

  1. Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain

    Ermengol Vallès, Begoña Benito, Jesús Jiménez, Sandra Cabrera, Oscar Alcalde, Carmen Altaba, Miguel Angel Guijo & Julio Martí-Almor

  2. Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Ermengol Vallès, Begoña Benito, Sandra Cabrera, Oscar Alcalde & Julio Martí-Almor

  3. Stony Brook University School of Medicine Health Science Center, T16-80, Stony Brook, NY, 11794, USA

    Roger Fan

Authors
  1. Ermengol Vallès
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  2. Begoña Benito
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  3. Jesús Jiménez
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  4. Sandra Cabrera
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  5. Oscar Alcalde
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  8. Roger Fan
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  9. Julio Martí-Almor
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Corresponding author

Correspondence to Ermengol Vallès.

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All authors have read and approved the submission. No financial support has been received from any institution or industry. The study was conducted following the Declaration of Helsinki. Informed consent was obtained from all patients participating in the study.

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Vallès, E., Benito, B., Jiménez, J. et al. Double factor single shot to diminish complications in cryoballoon ablation procedures for atrial fibrillation. J Interv Card Electrophysiol 55, 17–26 (2019). https://doi.org/10.1007/s10840-018-0483-3

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  • DOI: https://doi.org/10.1007/s10840-018-0483-3

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