Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation　- Impact of Different Ablation...

Area of Science:

• Electrophysiology
• Cardiovascular Interventions
• Cardiac Ablation

Background:

• The second-generation cryoballoon (CB2) is effective for pulmonary vein isolation (PVI).
• Limited data exists on how different ablation protocols impact the durability of PVI.
• This study addresses the durability of PVI using three distinct cryoballoon ablation strategies.

Purpose of the Study:

• To compare the durability of pulmonary vein isolation (PVI) after using three different cryoballoon ablation protocols.
• To evaluate the impact of bonus-freeze and time-to-effect-guided protocols on PVI durability in patients undergoing repeat procedures for atrial fibrillation or atrial tachycardia recurrence.

Main Methods:

• A total of 192 patients with recurrent atrial fibrillation or atrial tachycardia underwent repeat procedures.
• Patients were divided into three groups based on ablation strategy: bonus-freeze (n=31), no bonus-freeze (n=67), and time-to-effect-guided (n=94).
• Durability of PVI was assessed, and procedure times were recorded for each group.

Main Results:

• Persistent PVI was achieved in 55.8% of all pulmonary veins (PVs) and in 21% of patients with all PVs persistently isolated.
• No significant differences in the total rate of PV reconnection were observed between the three groups (P=0.134).
• Procedure times were significantly reduced in the no bonus-freeze (112.9±39.8 min) and time-to-effect-guided (86.67±28.4 min) groups compared to the bonus-freeze group (123.4±31.5 min).

Conclusions:

• No significant differences in durable pulmonary vein isolation were detected when comparing the three cryoballoon ablation protocols.
• Omitting the bonus-freeze cycle and utilizing individualized application times significantly reduced procedure times.
• These findings suggest that optimized ablation strategies can improve efficiency without compromising PVI durability.