Background

The search for a less invasive and lower cost cryoballoon-based strategy for atrial fibrillation (AF) ablation has resulted in a simplified procedure that may be suitable for cryoballoon ablation (CBA). Here, we compared procedural characteristics and outcomes between conventional CBA and simple CBA.

Methods

We enrolled 628 consecutive patients who underwent initial CBA for AF (age, 69 ± 12 years; female, 263 (42%); paroxysmal AF, 576 (92%); CHA₂DS₂-VASc score, 2.7 ± 1.6 points). Simple CBA was characterized by the minimal procedure required to isolate pulmonary veins, including the following: (1) CBA was performed without guidance from a 3-D mapping system; (2) a coronary sinus electrode and esophageal temperature probe were not used; (3) a waiting period after pulmonary vein isolation was not set; and AF induction by isoproterenol and atrial burst stimuli were not performed.

Results

Simple CBA was performed in 240 (38%) patients. Procedural time (49 ± 18 versus 85 ± 27 min, p < 0.01) was shorter, and total procedural costs (20,699 ± 8,091 versus 30,350 ± 11,647 US dollars, p < 0.01) were lower with simple CBA than conventional CBA. Freedom from AF recurrence during the 12-month study period (79.8% versus 78.4%, p = 0.52) and complication rate (8.8% versus 13.1%, p = 0.09) were similar between the two groups.

Conclusion

Compared with conventional CBA, simple CBA reduced procedural time and procedural costs while providing comparable outcomes.

中文翻译：

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用于阵发性心房颤动的简化冷冻球囊消融程序的安全性、有效性和成本效益

背景

寻找一种侵入性较小且成本较低的基于冷冻球囊的心房颤动 (AF) 消融策略已导致可能适用于冷冻球囊消融 (CBA) 的简化程序。在这里，我们比较了传统 CBA 和简单 CBA 之间的程序特征和结果。

方法

我们连续招募了 628 名接受初始 CBA 治疗 AF 的患者（年龄 69 ± 12 岁；女性，263 名（42%）；阵发性 AF，576 名（92%）；CHA ₂ DS ₂ -VASc 评分，2.7 ± 1.6 分）。简单 CBA 的特点是分离肺静脉所需的最小程序，包括以下内容： (1) CBA 是在没有 3-D 标测系统指导的情况下进行的；(2)未使用冠状窦电极和食管温度探头；(3)未设定肺静脉隔离后的等待期；未进行异丙肾上腺素和心房爆裂刺激的 AF 诱导。

结果

240 名 (38%) 患者进行了简单的 CBA。 与传统 CBA 相比，简单 CBA 的手术时间（49 ± 18 对 85 ± 27 分钟，p  < 0.01）更短，总手术成本（20,699 ± 8,091 对 30,350 ± 11,647 美元，p < 0.01）更低。在 12 个月的研究期间（79.8% 对 78.4%，p  = 0.52）和并发症发生率（8.8% 对 13.1%，p  = 0.09）在两组之间相似。

结论

与传统的 CBA 相比，简单的 CBA 减少了程序时间和程序成本，同时提供了可比的结果。