Clin Res Cardiol (2022).

Electrophysiology lab efficiency comparison between cryoballoon and point-by-point RF ablation: a German sub-analysis of the FREEZE Cohort Study
A. Metzner1, F. Straube2, R. R. Tilz3, M. Kuniss4, J. Tebbenjohanns5, D. Andresen6, H. Wieneke7, C. Stellbrink8, J. Franke9, U. Dorwarth2, M. Hochadel10, J. Senges11, E. Hoffmann2, K.-H. Kuck12
1Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Klinik für Kardiologie und Internistische Intensivmedizin, München Klinik Bogenhausen, München; 3Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; 4Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 5Med. Klinik I, Helios Klinikum Hildesheim GmbH, Hildesheim; 6Klinik für Innere Medizin und Angiologie, Evangelisches Krankenhaus Hubertus, Berlin; 7Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen GmbH, Essen; 8Klinik für Kardiologie und intern. Intensivmedizin, Klinikum Bielefeld Mitte, Bielefeld; 9CardioVascular Center Frankfurt, Frankfurt/Main; 10Medizinische Klinik B, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein; 11Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein; 12Kardiologie, LANS Cardio Hamburg, Hamburg;

Aim: Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent AF. This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA).

Methods: The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1,000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other.

Results: The analysis included 1,560 CBA patients and 1,344 RFA patients from the FREEZE Cohort. Some baseline patients’ characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p<0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1,285 hours with RFA and 253 hours with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% versus 11.5% days with one hour left, respectively).

Conclusion: CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage.