Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 19;2(3):290-297.
doi: 10.1016/j.hroo.2021.03.007. eCollection 2021 Jun.

Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters

Fehmi Keçe  1 , Marta de Riva  1 , Reza Alizadeh Dehnavi  1 , Adrianus P Wijnmaalen  1 , Bart J Mertens  2 , Martin J Schalij  1 , Katja Zeppenfeld  1 , Serge A Trines  1
Affiliations

Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters

Fehmi Keçe et al. Heart Rhythm O2. .

Abstract

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.

Keywords: Atrial fibrillation; Cryoballoon ablation; Dormant conduction; Pulmonary vein isolation; Time-to-isolation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Receiver operating characteristic curve predicting early reconnection/dormant conduction using the 3 parameters.
See this image and copyright information in PMC

References

    1. Kece F., Zeppenfeld K., Trines S.A. The impact of advances in atrial fibrillation ablation devices on the incidence and prevention of complications. Arrhythm Electrophysiol Rev. 2018;7:169–180. - PMC - PubMed
    1. Kece F., de Riva M., Naruse Y. Optimizing ablation duration using dormant conduction to reveal incomplete isolation with the second generation cryoballoon: a randomized controlled trial. J Cardiovasc Electrophysiol. 2019;30:902–909. - PMC - PubMed
    1. Osorio T.G., Coutino H.E., Brugada P., Chierchia G.B., De Asmundis C. Recent advances in cryoballoon ablation for atrial fibrillation. Expert Rev Med Devices. 2019:1–10. - PubMed
    1. Compier M.G., De Riva M., Dyrda K., Zeppenfeld K., Schalij M.J., Trines S.A. Incidence and predictors of dormant conduction after cryoballoon ablation incorporating a 30-min waiting period. Europace. 2015;17:1383–1390. - PubMed
    1. Macle L., Khairy P., Weerasooriya R. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet. 2015;386:672–679. - PubMed

LinkOut - more resources