Bonus-freeze: benefit or risk? Two-year outcome and procedural comparison of a “bonus-freeze” and “no bonus-freeze” protocol using the second-generation cryoballoon for pulmonary vein isolation

• DOI: 10.1007/s00392-016-0987-8
• Publication Date: 2016-04-16T08:22:01Z
• Authors: Christian-H. Heeger; Erik Wissner; Peter Wohlmuth; Shibu Mathew; Kentaro Hayashi; Christian Sohns; Bruno Reißmann; Christine Lemes; Tilman Maurer; Ardan M. Saguner; Francesco Santoro; Johannes Riedl; Feifan Ouyang; Karl-Heinz Kuck; Andreas Metzner
• Keywords: Male; Time Factors; Time Factor; 610 Medicine & health; Cryoballoon; Radiation Dosage; Radiography, Interventional; Pulmonary vein isolation; Cryosurgery; Risk Assessment; 2705 Cardiology and Cardiovascular Medicine; Cardiac Catheters; Electrocardiography; 03 medical and health sciences; 0302 clinical medicine; Retrospective Studie; Risk Factors; Ambulatory; Atrial Fibrillation; Humans; Long-term follow-up; Aged; Retrospective Studies; Original Paper; Interventional; Cardiac Catheter; Risk Factor; Pulmonary Vein; General Medicine; Equipment Design; Middle Aged; Radiation Exposure; Atrial fibrillation; 3. Good health; Radiography; Treatment Outcome; Pulmonary Veins; Fluoroscopy; 10209 Clinic for Cardiology; Electrocardiography, Ambulatory; Female; Cardiology and Cardiovascular Medicine; Human

Second-generation cryoballoon based pulmonary vein isolation has demonstrated encouraging acute and mid-term clinical outcome. Customarily, a bonus-freeze is applied after successful pulmonary vein isolation.To compare the long-term clinical outcome and safety profile of a bonus-freeze and a no bonus-freeze protocol.A total of 120 consecutive patients with paroxysmal [95/120 (79 %)] or persistent atrial fibrillation [25/120 (21 %)] underwent CB2-based PVI. Freeze-cycle duration was 240 s. In the first 60 patients a bonus-freeze was applied after successful PVI (group 1), while in the following 60 patients the bonus-freeze was omitted (group 2).Procedure and fluoroscopy times were significantly shorter in group 2 [113.8 ± 32 vs 138.2 ± 29 min (p = 0.03) and 19.2 ± 6 vs 24.3 ± 8 min (p = 0.02)]. No differences in procedural complications were found. During a mean follow-up of 849 ± 74 (group 1) and 848 ± 101 days (group 2, p = 0.13) 69 % of patients (group 1) and 67 % of patients (group 2) remained in stable sinus rhythm without any differences between the groups (p = 0.69).Freedom from atrial fibrillation after second-generation cryoballoon based pulmonary vein isolation and a follow-up of >2 years is comparable when applying a bonus- and a no bonus-freeze protocol, while procedure and fluoroscopy times are significantly shorter when omitting the bonus-freeze. No differences in periprocedural complications were identified.