Single 3‐Minute versus Double 4‐Minute Freeze Strategy for Second‐Generation Cryoballoon Ablation: A Single‐Center Experience

Abstract

CB-Adv ablation for PAF is highly effective, resulting in 78% 2-year freedom from arrhythmic recurrences. A "single 3-minute strategy" showed equal efficacy as compared to the conventional 4-minute plus bonus freeze approach at 2-year follow-up, providing shorter procedure and fluoroscopy time. Nadir temperature and time to PVI were predictors of arrhythmic recurrences. "Bonus-freeze" strategy might be unnecessary.

Pulmonary Vein Isolation Using a Second‐Generation Cryoballoon in Patients With Paroxysmal Atrial Fibrillation: One‐Year Outcome Using a Single Big‐Balloon 3‐Minute Freeze Technique

“…Indeed, Ciconte et al . recently reported that the AF freedom after a single 3‐minute approach and 4‐minute plus bonus freeze approach were similar . However, since all patients were treated with a single 3‐minute freeze technique and no control data about a standard 2 freeze technique was included in this study, the conclusion cannot be drawn from the present data.…”

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

“…In comparison to a single cycle, a two‐cycle freeze‐thaw strategy did not reduce AF recurrence rate and was associated with a higher complication rate 27 . A 4‐minute bonus application added to a 3‐minute baseline application did not reduce AF recurrences at 2 years of follow‐up 6 …”

“…Subsequent studies have reinforced fairly good midterm outcomes in patients submitted to CB ablation. However, the optimal freezing strategy is still under debate 3–7 . Prolonged freezing cycles may achieve more durable PVI at the cost of longer procedures and an increased risk of injury to extracardiac structures (eg, phrenic nerve, esophagus, bronchial tree) 8–10 .…”

Focal Transcatheter Cryoablation: Is a Four‐Minute Application Still Required?

“…It stands to reason that with faster and more intense freezing, a shorter ablation duration is required. Our results are consistent with a study by Ciconte et al ., which found that cryoballoon ablation duration for atrial fibrillation could be reduced from 4 to 3 minutes without compromising long‐term clinical outcomes …”

“…These observations provide further justification to pursue double freeze‐thaw cycles at successful sites pending more definitive evidence . There are, however, some data to suggest that a single freeze‐thaw cycle is sufficient for the current generation cryoballoon, which creates extensive encircling lesions to electrically isolate pulmonary veins . Double freeze‐thaw cycles remain the norm for cryoablation of other tissues including skin, liver, and prostate …”