The TTI guided 4 minutes freeze protocol was associated with a significantly higher rate of freedom from arrhythmia recurrence compared to the 3 minutes protocol (66.4% vs 56.1%, P=0.009).
Cohort (n=214)
Does a TTI guided 4 minutes freeze protocol improve freedom from arrhythmia recurrence compared to a 3 minutes freeze protocol in symptomatic AF patients undergoing cryoballoon pulmonary vein isolation?
A 4-minute freeze protocol during cryoballoon pulmonary vein isolation significantly improves freedom from arrhythmia recurrence compared to a 3-minute protocol, particularly in persistent AF, without increasing adverse events.
Absolute Event Rate: 66.4% vs 56.1%
p-value: p=0.009
BACKGROUND: Time-to-isolation (TTI) guided second-generation cryoballoon (CB2) ablation has been shown to be effective for pulmonary vein isolation (PVI). OBJECTIVE: The objective of this paper is to compare the safety and clinical outcome of CB2 PVI using the TTI guided 4 minutes vs 3 minutes freeze protocol. METHODS: This was a propensity-matched study based on an institutional database. Symptomatic atrial fibrillation (AF) patients who underwent CB2 PVI and systematic follow-up were consecutively included. RESULTS: A total of 573 patients were identified, of them 214 (107 matched-pairs) symptomatic AF (paroxysmal AF: 61%, persistent AF: 39%) patients (age: 67.7 ± 11.2 years) were analyzed. The baseline characteristics were comparable between the two groups. Procedural time was significantly longer in the 4 minutes group compared to 3 minutes group (67.2 ± 21.8 vs 55.9 ± 16.9 minutes, P < .0001). During a mean follow-up of 2 years, the 4 minutes group was associated with a significantly higher rate of freedom from arrhythmia recurrence compared with the 3 minutes group (66.4% vs 56.1%, P = .009), which was mainly driven by patients with persistent AF. The multivariate regression showed that the 4 minutes freeze was the independent predictor of freedom from arrhythmia recurrence. During the repeat procedure, the 4 minutes group was associated with a significantly higher rate of durable PVI. There was no difference regarding procedural adverse events between the two groups. CONCLUSION: As compared with the 3 minutes freeze, the TTI guided 4 minutes freeze is associated with a significantly higher rate of arrhythmia-free and durable PVI without compromising the safety profile, patients with persistent AF may benefit from the TTI guided 4 minutes freeze more pronouncedly.
Chen et al.（木曜日）は、症候性心房細動のコホートを行いました（n=214）。孤立までの時間をガイドとした4分凍結プロトコル対3分凍結プロトコルが不整脈再発の自由度に評価されました（p=0.009）。TTIに基づく4分凍結プロトコルは、3分プロトコルと比較して不整脈再発の自由度が有意に高い率であることと関連していました（66.4％対56.1％、P=0.009）。