Long‐Term Outcomes of Cryoballoon Pulmonary Vein Isolation Freeze Using a Modified ICE‐T Protocol With a Double 120 s Applications (ICE‐T 2 × 2)

ABSTRACT Background Cryoballoon (CB) pulmonary vein isolation (PVI) is a well‐established treatment for symptomatic atrial fibrillation (AF). Most centers use application durations of 180 or 240 s. Since freezing‐related complications tend to occur later during the application, empirically shortening the duration may reduce procedural risks. A protocol using two consecutive 120‐s freezes was proposed. Here, we report its long‐term outcomes. Methods We performed a long‐term follow‐up comparison of patients with symptomatic AF undergoing PVI with second‐generation CB between 2019 and 2020. The conventional single 240‐s freeze protocol (CB240) was compared to a modified double 120‐s freeze protocol (CB120). Among 160 consecutive patients, 80 received CB120 and 80 CB240. A total of 140 patients (70/group) completed follow‐up. The primary endpoint was freedom from atrial tachyarrhythmia. Results Persistent AF was more common in the CB240 group (32%) than in the CB120 group (20%), ( p < 0.05). After a mean follow‐up of 948 ± 517 days, freedom from any atrial tachyarrhythmia at 1 year was 90% in the CB120 group and 82% in the CB240 group (log‐rank p = 0.122). The primary outcome was assessed after a single procedure, including antiarrhythmic drug (AAD) use. Conclusions The CB120 protocol appears noninferior to the standard CB240 protocol regarding long‐term efficacy, while offering a potentially more favorable safety profile. This protocol may represent a viable alternative for optimizing the balance between effectiveness and safety.