On the Quest for the Best Freeze Predictors of Late Pulmonary Vein Reconnections After Second-Generation Cryoballoon Ablation

Giuseppe Ciconte, Giacomo Mugnai, Juan Sieira, Vedran Velagic, Yukio Saitoh, Ghazala Irfan, Burak Hunuk, Erwin Stroeker, Giulio Conte, Giacomo Di Giovanni, Giannis Baltogiannis, Kristel Wauters, Pedro Brugada, Carlo de Asmundis, Jean-Baptiste Chierchia

Research output: Contribution to journalArticlepeer-review

99 Citations (Scopus)

Abstract

Background The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation. Methods and Results A total of 29 consecutive patients (25 male, 86.2%; mean age 57.813.8 years) underwent a repeat procedure, after a mean 11.6 +/- 4.5 months (range, 3.5-19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI (P=0.03) and failure to achieve -40 degrees C within 60 s (P=0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73-0.97; P<0.001). Conclusions The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of -40 degrees C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.
Original languageEnglish
Pages (from-to)1359-1365
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number6
DOIs
Publication statusPublished - Dec 2015

Keywords

  • atrial fibrillation
  • cryoballoon ablation
  • pulmonary vein isolation
  • pulmonary vein reconnection
  • second-generation cryoballoon

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