Learning Curve of Cryo-balloon for Pulmonary Veins Isolation for Atrial Fibrillation - The 66th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery

Background: RF ablation for pulmonic veins isolation is well established therapy for patients with atrial fibrillation. However, the availability of this procedure is limited due to lengthy procedure and a long learning curve. The purpose of this study is to show that the use of Cryo-Balloon can overcome these difficulties.

Patients and Method: This is a historical cohort study based on 143 patients (2013-2017) with paroxysmal or persistent AF that had pulmonary veins isolation using Cryo-Balloon. Demographical and clinical data was collected that includes the CHA2DS2VASC score, medical therapy, previous DCCV, previous ablation, anti-coagulation therapy, ablation data. To evaluate the learning curve the success rate, the fluoroscopy time, the procedure time, the recurrence and the complication rate were compared for the first 30 patients (group I) to the remaining 113 patients (group II

Results: 143 patients (60.8% male) with a median follow up of 16 months, averaged age of 64.4 ± 8.9 years, 65% had persistent AF and 35% had paroxysmal AF. The average CHA₂DS₂VAS_C score was 2.3 ± 1.5. In the last follow 74.8% of patients were in sinus. A comparable fluoroscopy time (45.8±21 vs 40.3±17.4 minutes, P=0.35, respectively) and recurrence rate (33.3% vs 29.7%, P=0.704, respectively) were observed (group I vs group II). The procedure time was significantly shorter in group II compared to group I (2:03±0:32 vs 2:25±0:32 hours, P=0.003, respectively).

Conclusion: This study confirm the hypothesis that the use of cryo-balloon for isolation of pulmonic veins requires a short learning curve to achieve efficiency and safety similar to those used in the conventional method in the most experienced centers. Furthermore, a significant reduction in procedure time was observed as the study progressed and experience was accumulated. These results are encouraging and may improve the availability of ablation therapy for patients with atrial fibrillation.