{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:44:15Z","timestamp":1783557855368,"version":"3.55.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The optimal dosage of cryotherapy during cryoballoon ablation of pulmonary veins is still unclear. This trial tested the noninferiority of a novel, individualized, cryotherapy-dosing strategy for each vein.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p>\n              This prospective, randomized, multicenter, noninferiority study included 140 patients with paroxysmal atrial fibrillation, which was refractory to antiarrhythmic drugs. Patients were randomly assigned to a conventional strategy of 180-second cryoballoon applications per vein with a bonus freeze (control group, n=70) or to a shorter-time application protocol, with 1 application that lasted the time required for electric block time to effect plus 60- and a 120-second freeze bonus (study group, n=70). Patients were followed with a long-term monitoring system of 30 days. At 1-year follow-up, no difference was observed in terms of free atrial fibrillation-recurrence rates: 79.4% in control versus 78.3% in study group (\u0394=1.15%; 90% confidence interval, \u221210.33% to 12.63%;\n              <jats:italic>P<\/jats:italic>\n              =0.869). Time to effect was detected in 72.1% of veins. The control and study groups had similar mean number of applications per patient (9.6\u00b12 versus 9.9\u00b12.4;\n              <jats:italic>P<\/jats:italic>\n              =0.76). Compared with controls, the study group had a significantly shorter cryotherapy time (28.3\u00b17 versus 19.4\u00b14.3 minutes;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), left atrium time (104\u00b125 versus 92\u00b123 minutes;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), and total procedure time (135\u00b135 versus 119\u00b131 minutes;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). No differences were observed in complications or acute reconnections.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The new time-to-effect\u2013based cryotherapy dosage protocol led to shorter cryotherapy and procedure times, with equal safety, and similar acute and 1-year follow-up results, compared with the conventional approach.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT02789358.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.117.005318","type":"journal-article","created":{"date-parts":[[2017,12,16]],"date-time":"2017-12-16T01:10:48Z","timestamp":1513386648000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":59,"title":["Time-to-Effect\u2013Based Dosing Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation"],"prefix":"10.1161","volume":"10","author":[{"given":"\u00c1ngel","family":"Ferrero-de-Loma-Osorio","sequence":"first","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amaya","family":"Garc\u00eda-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Castillo-Castillo","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maite","family":"Izquierdo-de-Francisco","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Ib\u00e1\u00f1ez-Cr\u00edado","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Moreno-Arribas","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Bertomeu-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"L\u00f3pez-Mases","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Ajo-Ferrer","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"N\u00fa\u00f1ez","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lourdes","family":"Bondanza-Saavedra","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Miguel","family":"S\u00e1nchez-G\u00f3mez","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Gabriel","family":"Mart\u00ednez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"Chorro-Gasc\u00f3","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Ruiz-Granell","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Cl\u00ednico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602014"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1999.tb00353.x"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.12.026"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv024"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv189"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-015-0084-3"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.002966"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.12.014"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-013-9797-3"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn570"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.4022\/jafib.1429"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.10.033"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000228"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.07.005"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2005.40559.x"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eut366"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv452"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-016-0114-9"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12421"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu352"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu273"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.10.014"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.117.005760"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.117.005318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T08:24:06Z","timestamp":1738830246000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.117.005318"}},"subtitle":["Results of the plusONE Multicenter Randomized Controlled Noninferiority Trial"],"short-title":[],"issued":{"date-parts":[[2017,12]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1161\/CIRCEP.117.005318"],"URL":"https:\/\/doi.org\/10.1161\/circep.117.005318","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12]]},"assertion":[{"value":"2017-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-12-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e005318"}}