BACKGROUND The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. METHODS A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 s each) (the Cryo-AFConventional group n = 84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of - 40 °C within 60 s (the Cryo-AFDosing group n = 80) RESULTS: We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7 ± 0.8, with no difference between groups (Cryo-AFConventional, 8.7 ± 0.8 versus Cryo-AFDosing,8.6 ± 0.8; P = 0.359). The Cryo-AFDosing group required significantly less total cryotherapy application time (990.60 ± 137.77versus 1501.58 ± 89.60 s; P < 0.001) and left atrial dwell time (69.91 ± 6.91 versus 86.48 ± 7.03 min; P < 0.001) than the Cryo-AFConventional group. Additionally, the Cryo-AFDosing group required significantly less total procedure time (95.03 ± 6.50 versus 112.43 ± 7.11 min; P < 0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 min. The reconnection rates between the Cryo-AFConventional and Cryo-AFDosing groups were similar in that 2.98 and 0.94% of the initially isolated veins were reconnected, respectively, (P = 0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AFDosing group versus 78.57% in the Cryo-AFConventional group (P = 0.978). CONCLUSION A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.

中文翻译：

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阵发性房颤患者冷冻球囊导管消融的新型个性化策略。

背景技术冷冻消融房颤（Cryo-AF）的最佳剂量仍是未知的。为了评估个体化冷冻持续时间的疗效，我们比较了采用时间-肺静脉隔离（TT-PVI）或温度引导消融方案治疗的患者的临床结局与采用常规消融方案治疗的患者的结局。方法本研究共纳入164名连续患者。所采用的一种方法是常规剂量方案（每次至少两次应用，每次180 s）（Cryo-AF常规组n = 84），而第二种方法具有基于TT-PVI或达到-40的较短方案在60 s内达到摄氏温度（冷冻AF剂量组n = 80）结果：我们用1420例冷冻疗法治疗了656例肺静脉（PVs）。每位患者的平均应用次数为8.7±0.8，各组之间无差异（Cryo-AF常规为8.7±0.8，而冷冻AF剂量为8.6±0.8； P = 0.359）。冷冻AF给药组所需的总冷冻疗法应用时间（990.60±137.77比1501.58±89.60 s; P <0.001）和左房停留时间（69.91±6.91比86.48±7.03分钟; P <0.001）显着减少团体。此外，Cryo-AFDosing组所需的总手术时间显着减少（95.03±6.50 vs 112.43±7.11 min； P <0.001）。20分钟后，我们在13条静脉（1.98％）中观察到急性ATP诱导的或自发的静脉电重新连接。Cryo-AFConventional和Cryo-AFDosing组之间的重新连接率相近，分别是将最初孤立的静脉重新连接的2.98％和0.94％，（P ＝ 0.061）。一年随访后，游离房性心律失常的复发率没有差异，在冷冻AF给药组中为78.75％，而在冷冻AF常规组中为78.57％（P = 0.978）。结论可以采用以温度或TT-PVI为指导的新型Cryo-AF剂量方案，以个体化消融策略。该新方案可显着减少手术时间，冷冻能量剂量和左心房停留时间。与传统方法相比，该程序具有相同的安全性，并具有相似的急性和1年随访结果。结论可以采用以温度或TT-PVI指导的新型Cryo-AF剂量方案来个体化消融策略。该新方案可显着减少手术时间，冷冻能量剂量和左心房停留时间。与传统方法相比，该程序具有相同的安全性，并具有相似的急性和1年随访结果。结论可以采用以温度或TT-PVI指导的新型Cryo-AF剂量方案来个体化消融策略。该新方案可显着减少手术时间，冷冻能量剂量和左心房停留时间。与传统方法相比，该程序具有相同的安全性，并具有相似的急性和1年随访结果。