J Cardiovasc Electrophysiol. 2022 Sep 30. doi: 10.1111/jce.15697. Online ahead of print.
ABSTRACT
AIM: We conducted a systematic review and meta-analysis of randomized and observational studies with a control group to evaluate the effectiveness and safety of a time to isolation (TTI)-based strategy of cryoballoon ablation (CBA) in the treatment of atrial fibrillation (AF).
METHODS: Three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials and Embase) without language restrictions were searched. The intervention assessed was a TTI-based strategy of CBA in the treatment of AF. TTI was defined as the time from the start of freezing to the last recorded pulmonary veins’ potential. The comparison of interest was intended conventional protocol of CBA. The primary end point was freedom from atrial arrhythmia.
RESULTS: Nine studies were deemed eligible (N= 2289 patients). Eight studies reported freedom from atrial arrhythmia and pooled results showed a marginally similar success rate between two protocols (OR: 1.24; 95% CI: 0.98 – 1.56). A prespecified subgroup analysis verified that a high dose TTI strategy (with >120s duration of cryotherapy post TTI) compared to conventional protocol could significantly increase the patients without atrial arrhythmia during follow-up (OR: 1.39; 95% CI: 1.05 – 1.83). TTI strategy could also significantly decrease total procedure time (SMD: – 26.24 minutes; 95% CI: – 36.90 to – 15.57) and phrenic nerve palsy incidence (OR: 0.49; 95% CI 0.29 – 0.84).
CONCLUSION: Moderate confidence evidence suggests that an individualized CBA dosing strategy based on TTI and extended (> 2 minutes post TTI) duration of CBA is accompanied by fewer recurrences post AF ablation. This article is protected by copyright. All rights reserved.
PMID:36177697 | DOI:10.1111/jce.15697
