Abstract 11779: Third Generation Cryoballoon Facilitates Time-to-Isolation Dependent Freeze Protocols
The introduction of the 2nd generation cryoballoon (Medtronic Arctic Front Advance, AFA) increased efficacy of cryoballoon pulmonary vein (PV) isolation. Real time monitoring of the time-to-isolation (TTI) with a diagnostic spiral mapping catheter introduced through the cryoballoon inner lumen has emerged as a valuable parameter to estimate the quality of the ablation lesion. A short TTI appears to be predictive of a durable isolation, whereas a long TTI is linked to increased risk of PV reconnection. Real-time recording of TTI is limited in AFA due to a long distal tip of the balloon, which often inhibits registration of PV signals. A modification of the balloon design with a shorter tip (Medtronic Arctic Front Advance ST, AFA-ST) is supposed to facilitate registration of PV signals during isolation, because the spiral mapping catheter can be placed within the muscular sleeve of the PV. We have compared PV isolations with either the AFA-ST or the AFA cryoballoon and have implemented a protocol in the AFA-ST group depending on the observed TTI: In case of TTI <30s the freeze-cycle was reduced to 120s, in case of TTI of 30s or more the freeze cycle was set to 180s. If TTI was more than 60s we added a 180s bonus freeze. In contrast, in the AFA group all PVs were isolated by an initial freeze cycle of 240s followed by a 240s bonus freeze. We included 74 patients in this non-randomized case-control trial, with 37 patients in each group. In each group we identified 149 PVs. All PVs were isolated successfully. Mean procedure duration was 107 ±19 min in the AFA group and 85 ±20 min in the AFA-ST group (p<0.001). In the AFA group we registered a TTI in 83 PVs (55.7%), whereas TTI was documented in 122 PVs (81.9%) in the AFA-ST group (p<0.001). Mean TTI was 44 ±25s in the AFA group and 42 ±22 s in the AFA-ST group (p=0.25). Patients were followed-up for an average period of 6.2 ±2.9 months. The Kaplan-Meier estimated freedom from atrial arrhythmia recurrence 6 months after the procedure was 88.9% in the AFA group and 81.6% in AFA-ST group (p=0.300). In conclusion, we here demonstrate, that registration of TTI occurs significantly more frequent with the new AFA-ST cryoballoon. Thus tailoring of freeze cycle duration is feasible and leads to comparable clinical outcomes to standard fixed freeze cycles.
Author Disclosures: K. Petscher: None. A. Pott: None. W. Rottbauer: None. T. Dahme: Speakers Bureau; Modest; Medtronic.
- © 2016 by American Heart Association, Inc.