title: Comparison of resource utilization of pulmonary vein isolation: cryoablation versus RF ablation with three-dimensional mapping in the Value PVI Study.
abstract: BACKGROUND
  Point-to-point focal radiofrequency (RF) catheter ablation for aberrant pulmonary vein triggers that manifest into atrial fibrillation (AF) is the traditional method for treating symptomatic drug-resistant paroxysmal AF (PAF) when an ablation procedure is warranted. More recently, pulmonary vein isolation (PVI) using the cryoballoon has been demonstrated to be safe and effective (STOP AF clinical trial). Currently, two small studies have reviewed the procedural efficiency when comparing cryoballoon to focal RF catheter ablation procedures; however, no multicenter study has yet reported on this comparison of the two types of ablation catheters.
  
  
  METHODS
  A multicenter retrospective chart extraction and evaluation was conducted at seven geographically mixed cardiac care centers. The study examined procedural variables during ablation for PVI in PAF patients.
  
  
  RESULTS
  In several procedural measurements, the two modalities were comparable in efficiencies, including: acute PVI >96%; length of hospital stay at approximately 27 hours; and about 30% usage of adenosine after procedural testing. However, when compared to RF catheters, the cryoballoon procedure demonstrated a 13% reduction in laboratory occupancy time (247 min vs 283 min), a 13% reduction in procedure time (174 min vs 200 min), and a 21% reduction in fluoroscopy time (33 min vs 42 min). Additionally, when comparing the material usage of both cryoballoon and RF catheters, the cryoballoon used more radiopaque contrast agent (78 cc vs 29 cc) while using less intraprocedural saline (1234 cc vs 2386 cc), intracardiac echocardiography (88% vs 99%), three-dimensional electroanatomic mapping (30% vs 87%), and fewer transseptal punctures (1.5 vs 1.9).
  
  
  CONCLUSIONS
  This study is the first United States multicenter examination to report the procedural comparisons between the cryoballoon and focal RF catheters when used for the treatment of PAF patients. In this hospital chart review study, potential advantages were found when operating the cryoballoon with regard to hospital resource allocation. There was no statistical difference between cryoballoon and RF catheters for acute PVI success during the ablation procedure.
authors.affiliation: Arrhythmia Management, 1820 Preston Park Blvd, Plano, TX 75093 USA. THHBPEP@baylorhealth.edu.
authors.forename: J Brian
authors.initials: JB
authors.lastname: DeVille
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Svinarich
authors.forename: Dan
authors.initials: D
authors.lastname: Dan
authors.forename: Andrew
authors.initials: A
authors.lastname: Wickliffe
authors.forename: Charan
authors.initials: C
authors.lastname: Kantipudi
authors.forename: Hae W
authors.initials: HW
authors.lastname: Lim
authors.forename: Lisa
authors.initials: L
authors.lastname: Plummer
authors.forename: James
authors.initials: J
authors.lastname: Baker
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.forename: Hassan
authors.initials: H
authors.lastname: Baydoun
authors.forename: Mark
authors.initials: M
authors.lastname: Jenkins
authors.forename: Peter
authors.initials: P
authors.lastname: Chang-Sing
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D003452:Cryosurgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007755:Laboratories, Hospital / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D040841:Resource Allocation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology