Why the study?
Cryoballoon ablation protocols incorporate time-to-isolation (TTI) to shorten freeze cycles, but the impact of TTI on pulmonary vein isolation durability remained to be assessed.
Does a time-to-isolation (TTI)-guided ablation protocol improve the durability of pulmonary vein isolation compared to fixed freeze cycle protocols in patients undergoing cryoballoon ablation?
Does a time-to-isolation (TTI)-guided ablation protocol improve the durability of pulmonary vein isolation compared to fixed freeze cycle protocols in patients undergoing cryoballoon ablation?
A time-to-isolation-guided cryoballoon ablation protocol does not significantly improve the durability of pulmonary vein isolation compared to fixed freeze cycle protocols.
TTI-guided protocol shows no PV durability benefit in redo cases; leaves open whether individualized freezes improve outcomes in prospective trials.
BACKGROUND: Cryoballoon (CB)-based pulmonary vein isolation (PVI) has proven to be as effective as radiofrequency-based ablation. Different ablation protocols took the individual time-to-isolation (TTI) into account aiming at shorter but equally or even more effective freeze cycles. The current study sought to assess the impact of the TTI on PVI durability in patients undergoing a repeat procedure for recurrence of atrial tachyarrhythmia (ATA). METHODS AND RESULTS: In 205 patients with ATA recurrence after previous CB-based PVI, a total of 806 pulmonary veins (PVs) were identified. A total of 126 out of 806 PVs (16%) were previously treated with a TTI-guided ablation (Protocol #1; TTI + 120 s), in 92/806 (11%) PVs TTI was only monitored (m) but fixed freeze cycles were applied (Protocol #2; mTTI) and in 588/806 (73%) a fixed freeze cycle was applied without mTTI. There was no difference in the PV-reconduction rate between the groups (p = .23). The right inferior pulmonary vein (RIPV) showed overall significantly higher reconduction rates compared to the other PVs (RIPV-left inferior PV p < .003, -left superior PV p < .001, -right superior PV p < .013). Twenty-one patients (10%) were demonstrated to have only electrical reconduction of the RIPV, while all other PVs were still electrically isolated. CONCLUSIONS: The TTI-based CB ablation protocol did not show significant differences regarding PV-reconduction rates compared to the other ablation protocols.
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Rexha et al. (2022) studied this question.
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