Author:
Metzner Andreas,Straube Florian,Tilz Roland R.,Kuniss Malte,Noelker Georg,Tebbenjohanns Juergen,Andresen Dietrich,Wieneke Heinrich,Stellbrink Christoph,Franke Jennifer,Dorwarth Uwe,Carion Phuong Lien,Holbrook Reece,Hochadel Matthias,Senges Jochen,Hoffmann Ellen,Kuck Karl-Heinz,Wu L. Q.,Garcia-Alberola A.,Massa T.,Sabin G.,Franke A.,Souza J. J.,Stanley A.,Spitzer S. G.,Willems S.,Dierk T.,Chun K. R. J.,Borchard R.,Seidl K. H.,Zahn R.,Groschup G.,Obel I. W. P.,Brachmann J.,Gerds-Li J. H.,Gopal R. R.,Schrickel J.,Lewalter T.,Stanley A.,Moshage W.,Eckardt L.,Jung W.,Kremer P.,Lubinski A.,Schumacher B.,Lickfett L.,Münzel T.,Steinwender C.,Efremidis M.,Deneke T.,Nguyen D. Q.,
Abstract
Abstract
Background
Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (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. 1000 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 1560 CBA patients and 1344 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 (1285 h with RFA and 253 h 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% vs 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.
Clinical trial registration NCT01360008 (first registration 25/05/2011).
Funder
Universitätsklinikum Hamburg-Eppendorf (UKE)
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine