Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation

Arash Aryana; Giacomo Mugnai; Sheldon M Singh; Deep K Pujara; Carlo de Asmundis; Steve K Singh; Mark R Bowers; Pedro Brugada; André d'Avila; Padraig Gearoid O'Neill; Gian-Battista Chierchia

doi:10.1016/j.hrthm.2015.10.033

Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation

Heart Rhythm. 2016 Feb;13(2):424-32. doi: 10.1016/j.hrthm.2015.10.033. Epub 2015 Oct 28.

Affiliations

¹ Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California. Electronic address: Arash.Aryana@DignityHealth.org.
² Heart Rhythm Management Center, Vrije Universiteit Brussel, Brussels, Belgium.
³ Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.
⁵ Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
⁶ Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Santa Catarina, Brazil.

PMID: 26520204
DOI: 10.1016/j.hrthm.2015.10.033

Abstract

Background: Limited data exist on procedural and biophysical indicators of pulmonary vein (PV) isolation durability after the cryoballoon ablation of atrial fibrillation (AF).

Objective: The aim of this study was to investigate the procedural and biophysical characteristics associated with late PV reconnection (PVR) and durable PV isolation (PVI) after cryoablation using the currently available second-generation cryoballoon.

Methods: Data from 435 PVs targeted in 112 consecutive patients who underwent a repeat procedure 14 ± 3 months after an index cryoablation of AF were examined.

Results: Altogether, 111 PVs (25.5%) in 71 patients (63.4%) demonstrated PVR, whereas 324 PVs (74.5%) exhibited PVI. The number and duration of cryoballoon applications did not differ between PVR and PVI. However, the time to PV isolation (time to effect) was considerably shorter (39.1 ± 11.7 seconds vs 67.6 ± 19.7 seconds; P < .001), the balloon temperature at time to effect was significantly warmer (-32.1°C ± 7.8°C vs -39.4°C ± 5.8°C; P < .001), the balloon nadir temperature was slightly cooler (-48.7°C ± 4.6°C vs -47.8°C ± 2.9°C; P = .034), and the total thaw time (56.5 ± 25.4 seconds vs 34.8 ± 9.1 seconds; P < .001) and interval thaw times at 0°C (iTT0; 14.8 ± 10.9 seconds vs 7.1 ± 2.0 seconds; P < .001) and 15°C (54.2 ± 25.4 seconds vs 33.3 ± 9.1 seconds; P < .001) were notably longer with PVI than with PVR. However, only a time to effect of ≤60 seconds and an iTT0 of ≥10 seconds emerged as significant predictors of PV isolation durability. Consequently, in a multivariate model, presence of both criteria predicted <1% and their mere absence ~75% likelihood of PVR.

Conclusion: A time to effect of ≤60 seconds and an iTT0 of ≥10 seconds significantly predict PV isolation durability after the cryoballoon ablation of AF. If both criteria are met, the likelihood of PV reconnection may be exceedingly low.

Keywords: Ablation; Atrial fibrillation; Cryoballoon; Pulmonary vein isolation; Reconnection.

MeSH terms

Aged
Atrial Fibrillation* / physiopathology
Atrial Fibrillation* / surgery
Catheter Ablation* / adverse effects
Catheter Ablation* / methods
Clinical Protocols
Cryosurgery* / adverse effects
Cryosurgery* / instrumentation
Cryosurgery* / methods
Equipment Design
Female
Humans
Intraoperative Care / methods*
Male
Middle Aged
Operative Time
Postoperative Complications* / diagnosis
Postoperative Complications* / epidemiology
Pulmonary Veins / surgery*
Recurrence
Retrospective Studies
Time Factors
Treatment Outcome