Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters

• Published in: Heart Rhythm O2
• Main Authors: Fehmi Keçe, MD, PhD, Marta de Riva, MD, Reza Alizadeh Dehnavi, MD, PhD, Adrianus P. Wijnmaalen, MD, PhD, Bart J. Mertens, PhD, Martin J. Schalij, MD, PhD, Katja Zeppenfeld, MD, PhD, Serge A. Trines, MD, PhD
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2021
• Subjects: Atrial fibrillation; Cryoballoon ablation; Dormant conduction; Pulmonary vein isolation; Time-to-isolation; Diseases of the circulatory (Cardiovascular) system; RC666-701; Arctic
• Online Access: https://doi.org/10.1016/j.hroo.2021.03.007; https://doaj.org/article/75c35fd5405b4ac8b02daa740a5b2a17

Background: Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. Objective: To identify procedural and biophysical parameters predicting ERC. Methods: Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. Results: A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09–1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15–2.49], P = .008) and a longer TTI (HR 1.02 [1.01–1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. Conclusion: Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing.