Abstract 17085: Safety and Effectiveness of Atrial Fibrillation Ablation Using the Arctic Front Advance Cryoballoon With Reduced Dosing
Background: Second-generation cryoballoon Arctic Front Advance (AFA) (Medtronic, Minneapolis, MN) has been approved for atrial fibrillation (AF) with a more circumferential and wider ablation area. Complications have been reported with the use of standard 240 seconds freeze-thaw-freeze dosing. Reduced dosing with correlation to acute isolation has not been evaluated in terms of maintaining long-term success while reducing complication rate.
Methods: Single center retrospective review of 225 patients with AF ablation using AFA was performed (88 paroxysmal, 75 persistent, and 62 long-standing persistent). Dosing strategy of 120 seconds beyond acute isolation as assessed by circular mapping catheter Achieve catheter (Medtronic, Minneapolis, MN) was performed, with termination of the ablation at any time if nadir temperature is less than - 55 °C or a total ablation time of 180 second was reached. A repeat ablation after acute isolation was performed at 120 seconds. Procedural details of each ablation, complication rates, and clinical outcomes over 1 year were reviewed.
Results: All 225 patients underwent successful pulmonary vein (PV) isolation using AFA with reduced dosing strategy with an average dosing time of 146 seconds. Achieve recording to assess acute isolation was seen in 92% (846 of 920) of all of PV isolation, and average procedural time of 2.2 hours, fluoroscopy time of 4.2 minutes was seen. No significant complication was seen. Long-term success outcome was evaluated in 209 of 225 (97%) patient during follow-up. Freedom from AF assessment with standard protocol yielded a success rate of 87% at 3 months, 77% at 6 months, 81% at 9 months, and 76% at 12 months.
Conclusions: Treatment of AF with AFA cryoballoon with significantly reduced dosing is able to achieve acute PV isolation. Safety and success rate was comparable or superior compared to historical data. Adopting reduced dosing strategy is important in lowering complication rate by avoiding deeper ablation with longer ablation time.
- © 2013 by American Heart Association, Inc.