BACKGROUND: The optimal freeze duration in cryoballoon pulmonary vein isolation (PVI) is unknown. The 3rd generation cryoballoon facilitates observation of the time-to-isolation (TTI) and thereby enables individualized cryoenergy titration. To evaluate the efficacy of an individualized freeze duration we compared the clinical outcome of patients treated with a TTI-guided ablation protocol to the outcome of patients treated with a fixed ablation protocol. METHODS: We compared 100 patients treated with the 3rd generation cryoballoon applying a TTI-based protocol (TTI group) to 100 patients treated by a fixed freeze protocol (fixed group). In the fixed group a 240s freeze cycle was followed by a 240s bonus freeze after acute PV isolation. In the TTI group freeze duration was 180s if TTI was ≥30s and reduced to only 120s, if TTI was <30s. In case of a TTI >60s a 180s bonus freeze was applied. RESULTS: Freedom from atrial arrhythmia recurrence off class I/III antiarrhythmic drugs after one year was not different between the TTI group (73.6%) and the fixed group (75.7%; p=0.75). Mean procedure duration was 85.8±27.3min in the TTI group compared to 115.7±27.1min in the fixed group (p<0.001). Mean fluoroscopy time was 17.5±6.6min in the TTI group and 22.5±9.8min in the fixed group (p<0.001). CONCLUSIONS: TTI-guided cryoenergy titration leads to reduced procedure duration and fluoroscopy time and appears to be as effective as a fixed ablation strategy. A single 2-minute freeze seems to be sufficient in case of short TTI.
BACKGROUND: The optimal freeze duration in cryoballoon pulmonary vein isolation (PVI) is unknown. The 3rd generation cryoballoon facilitates observation of the time-to-isolation (TTI) and thereby enables individualized cryoenergy titration. To evaluate the efficacy of an individualized freeze duration we compared the clinical outcome of patients treated with a TTI-guided ablation protocol to the outcome of patients treated with a fixed ablation protocol. METHODS: We compared 100 patients treated with the 3rd generation cryoballoon applying a TTI-based protocol (TTI group) to 100 patients treated by a fixed freeze protocol (fixed group). In the fixed group a 240s freeze cycle was followed by a 240s bonus freeze after acute PV isolation. In the TTI group freeze duration was 180s if TTI was ≥30s and reduced to only 120s, if TTI was <30s. In case of a TTI >60s a 180s bonus freeze was applied. RESULTS: Freedom from atrial arrhythmia recurrence off class I/III antiarrhythmic drugs after one year was not different between the TTI group (73.6%) and the fixed group (75.7%; p=0.75). Mean procedure duration was 85.8±27.3min in the TTI group compared to 115.7±27.1min in the fixed group (p<0.001). Mean fluoroscopy time was 17.5±6.6min in the TTI group and 22.5±9.8min in the fixed group (p<0.001). CONCLUSIONS:TTI-guided cryoenergy titration leads to reduced procedure duration and fluoroscopy time and appears to be as effective as a fixed ablation strategy. A single 2-minute freeze seems to be sufficient in case of short TTI.
Authors: Aakash A Bavishi; Rachel M Kaplan; Graham Peigh; Celso L Diaz; Jayson R Baman; Amar Trivedi; Jeremiah Wasserlauf; Mark J Shen; Prasongchai Sattayaprasert; Alexandru B Chicos; Susan Kim; Nishant Verma; Rishi Arora; Albert Lin; Bradley P Knight; Rod S Passman Journal: Pacing Clin Electrophysiol Date: 2019-04-09 Impact factor: 1.976
Authors: Ravi B Patel; Caitlin Somerville; Fei Fei Gong; Andrew C Peters; Sanjiv J Shah; Alexandru B Chicos; Susan Kim; Bradley P Knight; Albert Lin; Nishant Verma; Rod S Passman Journal: J Atr Fibrillation Date: 2020-04-30
Authors: Alexander Pott; Michael Baumhardt; Karolina Weinmann; Manuel Rattka; Tilman Stephan; Mirjam Keßler; Carlo Bothner; Kerstin Petscher; Wolfgang Rottbauer; Tillman Dahme Journal: Int J Cardiol Heart Vasc Date: 2019-04-30
Authors: Manuel Rattka; Alexander Pott; Anna Kühberger; Karolina Weinmann; Dominik Scharnbeck; Tilman Stephan; Michael Baumhardt; Carlo Bothner; Mario Iturbe Orbe; Wolfgang Rottbauer; Tillman Dahme Journal: Europace Date: 2020-09-01 Impact factor: 5.214
Authors: Alexander Pott; Hagen Wirth; Yannick Teumer; Karolina Weinmann; Michael Baumhardt; Christiane Schweizer; Sinisa Markovic; Dominik Buckert; Carlo Bothner; Wolfgang Rottbauer; Tillman Dahme Journal: Front Cardiovasc Med Date: 2021-12-14
Authors: Alexander Pott; Michael Baumhardt; Mohammad Al-Masalmeh; Alexander Wolf; Matthias Schiele; Christiane Schweizer; Carlo Bothner; Deniz Aktolga; Yannick Teumer; Karolina Weinmann; Wolfgang Rottbauer; Tillman Dahme Journal: J Cardiovasc Dev Dis Date: 2022-08-23