Atrial fibrillation ablation with the second generation cryoballoon: Multicenter propensity score matched comparison between freezing strategies

Ströker, Erwin; Kupics, Kaspars; Asmundis, Carlo de; Mugnai, Giacomo; Regibus, Valentina De; Cocker, Jeroen De; Stockman, Dirk; Iacopino, Saverio; Sieira-Moret, Juan; Brugada, Pedro; Schwagten, Bruno; Greef, Yves De; Chierchia, Gian‐Battista

doi:10.1016/j.ijcard.2017.11.069

Cited by 9 publications

(6 citation statements)

References 21 publications

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“…Our subgroup analysis shows that single-shot technique appears to be safer for the safety of ablation, and complications of TTI-guided groups are significantly lower than those in single-shot freeze and standard technique groups. In addition, consistent with previous studies ( 29 , 31 , 32 ), we also found that the single-shot technique group significantly shortened the total operation time, freeze time and fluoroscopy time without increase of the procedure risk, which was beneficial to accelerate the turnover of the operating room. Interestingly, Heeger et al ( 46 ) found that in patients with premature CB application abortion due to PNP, a high rate of persistent PVI was found at repeat procedures.…”

Section: Discussionsupporting

confidence: 91%

“…Total operation time was reported in 15 studies( 8 , 13 – 17 , 22 – 25 , 27 , 29 – 32 ), freeze time in 8 studies( 8 , 13 , 15 , 22 , 24 , 26 , 29 , 31 ) , and fluoroscopy time in 14 studies( 8 , 13 – 15 , 17 , 22 – 25 , 27 , 30 – 33 ). The results showed that the total operation time of single-shot technique group was significantly shorter than that of standard technique group.…”

Section: Resultsmentioning

confidence: 99%

“…Abstracts were independently screened by two investigators. Finally, a total of 17 qualified studies met our inclusion criteria, including 6 prospective studies (15,(22)(23)(24)(25)(26) and 11 retrospective studies (8,13,14,17,(27)(28)(29)(30)(31)(32)(33), including 4,688 patients with AF (2,526 in single-shot technique group and 2,162 in standard technique group). In two multicenter studies (17, 29), the only two subgroups, including bonus-freeze protocol group and the timeto-effect protocol group, were extracted due to their comparability.…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

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Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies

He,

Zhang,

Yin

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAlthough there are many freezing protocols available, the optimal freezing dose is still not determined. We aimed to evaluate the effectiveness and safety of different freeze strategies of CBA in the treatment of AF.MethodsPubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st December 2022. Studies comparing the outcomes between single-shot technique and standard technique of cryoablation were included. Subgroup analysis identified potential determinants for single-shot technique procedure.ResultsOur search resulted in 3407 records after deduplication. A total of 17 qualified studies met our inclusion criteria. Compared with standard technique, single-shot technique of cryoablation has a comparable rate of freedom from AF/AT(RR 1.00; P = 0.968), a trend for lower rate of procedure complications (RR 0.80; P = 0.069), a lower rate in transient phrenic paralysis (t-PNP) (RR 0.67; P = 0.038), a similar rate in persistent phrenic paralysis (per-PNP) (RR 1.15; P = 0.645), as well as a comparable procedure parameters. Importantly, potentially significant treatment covariable interactions in procedure complications were found in freeze strategy subgroup, male proportion subgroup and age subgroup, including single-shot freeze (RR 1.02; P = 0.915) and TTI-guided (RR 0.63; P = 0.007) with interaction P = 0.051, high male proportion (RR 0.54; P = 0.005) and a low male proportion (RR 0.94; P = 0.759) with interaction P = 0.074, as well as age ≥ 65 (RR0.91; P = 0.642) and age <65 (RR 0.54; P = 0.006),interaction P = 0.090. Meanwhile, only one significant treatment covariable interactions in procedure complications was found in the hypertension subgroup, including HT > 60% (RR 0.89; P = 0.549) and HT ≤ 60% (RR 0. 46; P < 0.01) with interaction P = 0.043.ConclusionsOur study suggested that single-shot technique of cryoablation has comparable effective and safety outcomes for AF ablation compared to standard technique.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies

He,

Zhang,

Yin

et al. 2023

Front. Cardiovasc. Med.

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“…The improved CBA efficiency of the second and third generations along with the recording of time to isolation (TTI) of PVs have created the need for the evaluation of different dosing protocols focusing on an individualized cryotherapy strategy rather than the initially proposed conventional protocol of CBA 5–7 …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] The improved CBA efficiency of the second and third generations along with the recording of time to isolation (TTI) of PVs have created the need for the evaluation of different dosing protocols focusing on an individualized cryotherapy strategy rather than the initially proposed conventional protocol of CBA. [5][6][7] In recent years, clinical and preclinical studies have evaluated the optimal CBA dosing based on different TTI protocols with a focus on determining the shortest effective freezing duration. [8][9][10][11][12][13][14] TTI has emerged as a powerful marker of acute 8 and durable 9,10,15 PV isolation, and has also been instrumental in reducing the need for the number of cryoapplications as well as the procedural duration and fluoroscopic utilization 13,14 but the efficacy and safety of this index still remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of a time to isolation strategy of cryoballoon ablation of atrial fibrillation: A systematic review and meta‐analysis

Tsiachris

Doundoulakis

Antoniou

et al. 2022

Cardiovasc electrophysiol

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Aim We conducted a systematic review and meta‐analysis of randomized and observational studies with a control group to evaluate the effectiveness and safety of a time to isolation (TTI)‐based strategy of cryoballoon ablation (CBA) in the treatment of atrial fibrillation (AF). Methods Three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions were searched. The intervention assessed was a TTI‐based strategy of CBA in the treatment of AF. TTI was defined as the time from the start of freezing to the last recorded pulmonary veins' potential. The comparison of interest was intended conventional protocol of CBA. The primary endpoint was freedom from atrial arrhythmia. Results Nine studies were deemed eligible (N = 2289 patients). Eight studies reported freedom from atrial arrhythmia and pooled results showed a marginally similar success rate between the two protocols (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 0.98–1.56). A prespecified subgroup analysis verified that a high dose TTI strategy (with >120 s duration of cryotherapy post‐TTI) compared to the conventional protocol could significantly increase the patients without atrial arrhythmia during follow‐up (OR: 1.39; 95% CI: 1.05–1.83). TTI strategy could also significantly decrease total procedure time (SMD: −26.24 min; 95% CI: −36.90 to −15.57) and phrenic nerve palsy incidence (OR: 0.49; 95% CI: 0.29–0.84). Conclusion Moderate confidence evidence suggests that an individualized CBA dosing strategy based on TTI and extended (>2 min post‐TTI) duration of CBA is accompanied by fewer recurrences post‐AF ablation.

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Comparison for the efficacy and safety of time-to-isolation protocol and conventional protocol of cryoballoon in the treatment of atrial fibrillation: a meta-analysis and systematic review

Liu

Wang

et al. 2020

J Interv Card Electrophysiol

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Atrial fibrillation ablation with the second generation cryoballoon: Multicenter propensity score matched comparison between freezing strategies

Cited by 9 publications

References 21 publications

Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies

Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies

Effectiveness and safety of a time to isolation strategy of cryoballoon ablation of atrial fibrillation: A systematic review and meta‐analysis

Comparison for the efficacy and safety of time-to-isolation protocol and conventional protocol of cryoballoon in the treatment of atrial fibrillation: a meta-analysis and systematic review

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