Predictors of Durable Electrical Isolation in the Setting of Second Generation Cryoballoon Ablation: A Comparison between Left Superior, Left Inferior, Right Superior and Right Inferior Pulmonary Veins

AIM OF THE STUDY: to assess specific per-vein procedural predictors of PV late reconnection in cryoballoon ablation (CbA) METHODS AND RESULTS: we enrolled 148 consecutive patients undergoing a redo procedure after a previous index CbA. A reconnection in at least 1 pulmonary vein (PV) was found in 80 patients (54.1%) and the most frequently reconnected PV was the right inferior (RIPV). Overall, PV reconnection was associated with longer time to -40°C (Tt-40°C) (54.4±21.7 vs. 67.6±27.6 sec; p<0.001), warmer nadir temperature (NT) (-49.7±5.4 vs. -46.5±5.8 °C; p<0.001) and temperature at 60 seconds (-41.8±4.5 vs. -39.8±4.2 °C; p<0.001). The performance of these predictors differed between the veins. In particular, a comparable behavior was observed for left superior pulmonary vein (LSPV) and right superior pulmonary vein (RSPV) where NT ≤ -48°C showed a sensibility and a specificity respectively of 62% and 65% and 71% and 72% in predicting durable PVI. For RIPV, NT≤-48°C showed a sensitivity of 74% but low specificity (53%). Tt -40°C< 60sec showed good negative predictive values, respectively: 83.9% for LSPV, 94.9% for LIPV, 90.2% for RSPV and 82.7% for RIPV. Previous predictors cannot be used for LIPV.

CONCLUSIONS: freezing behavior and reconnection rates differ significantly among the four PVs. Freezing temperature parameters strongly predict late PV reconnection (PVr) in superior PVs and are slightly different in RIPV but can be applied as well. LIPV freezing behavior is the most different. Its reconnection is uncommon even in the subset of worse freezing temperatures and specific CB predictors cannot be identified. This article is protected by copyright. All rights reserved.