title: Early experience with the cryoablation balloon procedure for the treatment of atrial fibrillation by an experienced radiofrequency catheter ablation center.
abstract: BACKGROUND
  Radiofrequency (RF) catheter ablation has provided an effective method for treating drug-refractory symptomatic atrial fibrillation. Recently, a cryoablation balloon approach has also received approval. The purpose of this study was to compare RF catheter ablation to cryoablation for the treatment of atrial fibrillation with respect to safety, immediate efficacy, and effects on procedural and fluoroscopy times. In addition, actual procedural costs were compared.
  
  
  METHODS
  This study was approved by the Winthrop University Hospital Institutional Review Board to retrospectively examine cryoablation with the Arctic Front Cardiac CryoAblation balloon catheter (Medtronic, Inc) and compare it to RF catheter ablation for the treatment of drug-refractory symptomatic atrial fibrillation. Patient and procedural characteristics as well as immediate success were compared. Immediate failure was defined as incomplete pulmonary vein isolation of all veins.
  
  
  RESULTS
  A total of 124 procedures (62 RFs and 62 cryoablations) were performed from December 2010 through July 2012. The cryoablation procedure took longer to perform than RF (171 ± 61 minutes vs 126 ± 49 minutes, respectively; P<.0001). There was no difference in fluoroscopy times between the two groups (29 ± 20 minutes for RF vs 32 ± 18 minutes for cryoablation; P=.39). The infusion of protamine following procedures was much more common in the cryoablation group (30 patients vs 2 patients in the RF group; P<.0001). The immediate success rate was 93.5% with RF ablation vs 96.7% with cryoablation (P=NS). There was not a significant difference in complications between the two approaches. The cost for each procedure was $24,391.88 ± 4826.77 for RF and $31,874.02 ± 8349.70 for cryoablation (P<.0001).
  
  
  CONCLUSIONS
  Cryoablation provides an additional and alternative approach to RF ablation for the treatment of symptomatic drug-refractory atrial fibrillation with comparable immediate success and complications. It is synergistic with RF and permits the ability to tackle the entire gamut of atrial fibrillation (ie, paroxysmal and persistent). This study showed no decrease in procedural or fluoroscopy times with our early experience. One significant limitation with cryoablation is the cost. Cryoablation resulted in over $7000 extra cost to the hospital per procedure. The clinical benefits achieved by this additional cost warrant further investigation.
authors.affiliation: Department of Medicine at Winthrop University Hospital, Mineola, New York, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mandell
authors.forename: Frank
authors.initials: F
authors.lastname: Amico
authors.forename: Sameer
authors.initials: S
authors.lastname: Parekh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Snow
authors.forename: Joseph
authors.initials: J
authors.lastname: Germano
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000191:economics / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome