Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study

for the FREEZE Cohort Study Investigators

doi:10.1186/s12872-022-03015-8

Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study

for the FREEZE Cohort Study Investigators

Department of Internal Medicine II

10 Citations (Scopus)

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).

Original language	English
Article number	8
Journal	BMC cardiovascular disorders
Volume	23
Issue number	1
ISSN	1471-2261
DOIs	https://doi.org/10.1186/s12872-022-03015-8
Publication status	Published - 12.2023

Funding

The authors would like to thank Kelly Bragt and Alicia Sale from Medtronic for providing support on the analyses and model validation, and Steffen Schneider from IHF for providing support on the analyses and the manuscript. The authors would also like to thank the other members of the FREEZE Cohort Study, K. Wegscheider, T. Ouarrak, T. Massa, G. Sabin, A. Franke, S. G. Spitzer, S. Willems, T. Dierk, J. K. R. Chun, R. Borchard, K. H. Seidl, R. Zahn, G. Groschup, J. Brachmann, J. H. Gerds-Li, J. Schrickel, T. Lewalter, W. Moshage, L. Eckardt, W. Jung, P. Kremer, B. Schumacher, L. Lickfett, T. Münzel, T. Deneke, D. Q. Nguyen. This analysis has been presented to the DGK 88th Annual Conference April 2022. Clinical Research in Cardiology (2022) 111:592. https://dgk.org/kongress_programme/jt2022/abstracts/aV1041.html?q=freeze. FREEZE Cohort Study Investigators15L. Q. Wu,16A. Garcia-Alberola,17T. Massa,18G. Sabin,19A. Franke,20J. J. Souza,21A. Stanley,22S. G. Spitzer,23S. Willems,24T. Dierk,25K. R. J. Chun,26R. Borchard,27K. H. Seidl,28R. Zahn,29G. Groschup,30I. W. P. Obel,31J. Brachmann,32J. H. Gerds-Li,33R. R. Gopal,34J. Schrickel,35T. Lewalter,36A. Stanley,37W. Moshage,38L. Eckardt,39W. Jung,40P. Kremer,41A. Lubinski,42B. Schumacher,43L. Lickfett,44T. Münzel,45C. Steinwender,46M. Efremidis,47T. Deneke,48D. Q. Nguyen.15Shanghai Rui Jin Hospital, Shanghai, China;16Univ. Hospital Virgen d.l. Arrixaca, Murcia, Spain;17Klinikum Frankfurt Höchst, Frankfurt, Germany;18Elisabeth-Krankenhaus Essen, Essen, Germany;19Klinikum Siloah, Hannover, Germany;20Mission Hospital Inc., Ashville, NC, USA,21Sunninghill Hospital 1, Sandton, South Africa;22Praxisklinik Herz und Gefaesse, Dresden, Germany;23Univ. Herzzentrum Hamburg-Eppend., Hamburg, Germany;24Universitätsklinikum Heidelberg, Heidelberg, Germany;25Cardioangiologisches Centrum Bethanien, Frankfurt, Germany;26Herzzentrum Duisburg, Duisburg, Germany;27Klinikum Ingolstadt, Ingolstadt, Germany;28Klinikum Ludwigshafen, Ludwigshafen, Germany;29Klinikum Aschaffenburg, Aschaffenburg, Germany;30Milpark Hosp., Johannesburg, South Africa;31Klinikum Coburg, Coburg, Germany;32Deutsches Herzzentrum Berlin, Berlin, Germany;33Panorama Medi-Clinic, Cape Town, South Africa;34Universitätsklinikum Bonn, Bonn, Germany;35Isar Herzzentrum, Munich, Germany;36Sunninghill-Hospital 2, Sandton, South Africa;37Klinikum Traunstein, Traunstein, Germany;38Universitätsklinikum Münster, Münster, Germany;39Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany;40Albetinen-KH, Hamburg, Germany;41Uniwersytecki Szpital Kliniczny, Wrocław, Poland;42Westpfalz-Klin., Kaiserslautern, Germany;43Städt. Klin. Mönchengladbach, Mönchengladbach, Germany;44Universitätsklinikum Mainz, Mainz, Germany;45Allg. Krankenhaus Linz, Linz, Austria;46Evangelismos Gen. Hosp., Athen, Greece;47Herz-/Gefäßklinik Bad Neustadt, Bad Neustadt a. d. Saale, Germany;48St. Vinzenz Hospital Köln-Nippes, Cologne, Germany. Open Access funding enabled and organized by Projekt DEAL. This work was supported by Medtronic Inc.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

2.22-12 Cardiology, Angiology

Access to Document

10.1186/s12872-022-03015-8

Cite this

@article{5bc47c48c448460f98203b4dbd64ae5c,

title = "Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study",

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{\textquoteright} 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).",

author = "\{for the FREEZE Cohort Study Investigators\} and Andreas Metzner and Florian Straube and Tilz, \{Roland R.\} and Malte Kuniss and Georg Noelker and Juergen Tebbenjohanns and Dietrich Andresen and Heinrich Wieneke and Christoph Stellbrink and Jennifer Franke and Uwe Dorwarth and Carion, \{Phuong Lien\} and Reece Holbrook and Matthias Hochadel and Jochen Senges and Ellen Hoffmann and Kuck, \{Karl Heinz\} and Wu, \{L. Q.\} and A. Garcia-Alberola and T. Massa and G. Sabin and A. Franke and Souza, \{J. J.\} and A. Stanley and Spitzer, \{S. G.\} and S. Willems and T. Dierk and Chun, \{K. R.J.\} and R. Borchard and Seidl, \{K. H.\} and R. Zahn and G. Groschup and Obel, \{I. W.P.\} and J. Brachmann and Gerds-Li, \{J. H.\} and Gopal, \{R. R.\} and J. Schrickel and T. Lewalter and A. Stanley and W. Moshage and L. Eckardt and W. Jung and P. Kremer and A. Lubinski and B. Schumacher and L. Lickfett and T. M{\"u}nzel and C. Steinwender and M. Efremidis and T. Deneke",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1186/s12872-022-03015-8",

language = "English",

volume = "23",

journal = "BMC cardiovascular disorders",

issn = "1471-2261",

number = "1",

}

TY - JOUR

T1 - Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation

T2 - a German sub-analysis of the FREEZE Cohort study

AU - for the FREEZE Cohort Study Investigators

AU - Metzner, Andreas

AU - Straube, Florian

AU - Tilz, Roland R.

AU - Kuniss, Malte

AU - Noelker, Georg

AU - Tebbenjohanns, Juergen

AU - Andresen, Dietrich

AU - Wieneke, Heinrich

AU - Stellbrink, Christoph

AU - Franke, Jennifer

AU - Dorwarth, Uwe

AU - Carion, Phuong Lien

AU - Holbrook, Reece

AU - Hochadel, Matthias

AU - Senges, Jochen

AU - Hoffmann, Ellen

AU - Kuck, Karl Heinz

AU - Wu, L. Q.

AU - Garcia-Alberola, A.

AU - Massa, T.

AU - Sabin, G.

AU - Franke, A.

AU - Souza, J. J.

AU - Stanley, A.

AU - Spitzer, S. G.

AU - Willems, S.

AU - Dierk, T.

AU - Chun, K. R.J.

AU - Borchard, R.

AU - Seidl, K. H.

AU - Zahn, R.

AU - Groschup, G.

AU - Obel, I. W.P.

AU - Brachmann, J.

AU - Gerds-Li, J. H.

AU - Gopal, R. R.

AU - Schrickel, J.

AU - Lewalter, T.

AU - Stanley, A.

AU - Moshage, W.

AU - Eckardt, L.

AU - Jung, W.

AU - Kremer, P.

AU - Lubinski, A.

AU - Schumacher, B.

AU - Lickfett, L.

AU - Münzel, T.

AU - Steinwender, C.

AU - Efremidis, M.

AU - Deneke, T.

PY - 2023/12

Y1 - 2023/12

N2 - 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).

AB - 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).

UR - https://www.scopus.com/pages/publications/85145957621

U2 - 10.1186/s12872-022-03015-8

DO - 10.1186/s12872-022-03015-8

M3 - Journal articles

C2 - 36624380

AN - SCOPUS:85145957621

SN - 1471-2261

VL - 23

JO - BMC cardiovascular disorders

JF - BMC cardiovascular disorders

IS - 1

M1 - 8

ER -

Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study

Abstract

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UN SDGs

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DFG Research Classification Scheme

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