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Multicenter Study
. 2023;30(4):534-542.
doi: 10.5603/CJ.a2021.0135. Epub 2021 Oct 28.

Time to -30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation

Carlos Antonio Álvarez-Ortega  1   2 , Miguel Angel Ruiz  3 , César Solórzano-Guillén  4 , Alberto Barrera  5 , Jorge Toquero-Ramos  6 , Jesús Daniel Martínez-Alday  7   8 , Carlos Grande  9 , José María Segura  10 , Arcadio García-Alberola  11 , Pablo Moriña-Vázquez  12 , Ángel Ferrero-de-Loma-Osorio  13   14 , Roger Villuendas  15 , Rocío Cózar  16   17 , Maria Fe Arcocha  18 , Alicia Ibañez  19 , Rafael Peinado  4
Affiliations
Multicenter Study

Time to -30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation

Carlos Antonio Álvarez-Ortega et al. Cardiol J. 2023.

Abstract

Background: Freezing rate of second-generation cryoballoon (CB) is a biophysical parameter that could assist pulmonary vein isolation. The aim of this study is to assess freezing rate (time to reach -30°C ([TT-30C]) as an early predictor of acute pulmonary vein isolation using the CB.

Methods: Biophysical data from CB freeze applications within a multicenter, nation-wide CB ablation registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein isolation. And SA with time to isolation under 60 s (SA-TTI<60) as achieving durable vein isolation in under 60 s. Logistic regressions were performed and predictive models were built for the data set.

Results: 12,488 CB applications from 1,733 atrial fibrillation (AF) ablation procedures were included within 27 centers from a Spanish CB AF ablation registry. SA was achieved in 6,349 of 9,178 (69.2%) total freeze applications, and SA-TTI<60 was obtained in 2,673 of 4,784 (55.9%) freezes where electrogram monitoring was present. TT-30C was shorter in the SA group (33.4 ± 9.2 vs 39.3 ± 12.1 s; p < 0.001) and SA-TTI<60 group (31.8 ± 7.6 vs. 38.5 ± 11.5 s; p < 0.001). Also, a 10 s increase in TT-30C was associated with a 41% reduction in the odds for an SA (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.56-0.63) and a 57% reduction in the odds for achieving SA-TTI<60 (OR 0.43; 95% CI 0.39-0.49), when corrected for electrogram visualization, vein position, and application order.

Conclusions: Time to reach -30°C is an early predictor of the quality of a CB application and can be used to guide the ablation procedure even in the absence of electrogram monitoring.

Keywords: atrial fibrillation; atrial fibrillation ablation; cryoballoon ablation; pulmonary vein isolation; second-generation cryoballoon.

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Conflict of interest statement

Conflict of interest: Jorge Toquero-Ramos received lecture honoraria from Medtronic Inc. and is a Member of the Medtronic European Advisory Board; Jesús Daniel Martínez-Alday received educational honoraria from Medtronic Inc. and Abbott Inc.; Arrhythmia Unit of Hospital Clínico Universitario of Valencia is a training center in the Arctic Front Training Program (AFTP), funded by Medtronic Inc.; Pablo Moriña-Vázquez received consulting honoraria from Medtronic Inc. and Abbott Inc.; Ángel Ferrero-de-Loma-Osorio has received lecture honoraria from Medtronic Inc.; Hospital Virgen de la Arrixaca (Murcia) received grants/research financial support from Medtronic; Rafael Peinado declares educational and research grants from Medtronic Inc. The rest of the authors do not declare any potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart and classification of cryoballoon applications. Successful application refers to achieving vein isolation; TTI — time to isolation.
Figure 2
Figure 2
Multivariate logistic regression models predicting successful cryoballon application.
Figure 3
Figure 3
Multivariate logistic regression models predicting a successful cryoballoon application achieving vein isolation within 60 s.
Figure 4
Figure 4
Predicted probability of successful application with time to isolation (TTI) under 60 s for different times to reach −30°C (s). Data were derived from the logistic models.
Figure 5
Figure 5
Scatter plot of recorded nadir temperature and time to −30°C; A, B. Green dots represent successful applications, and red dots represent failure to isolate; C, D. Green dots represent isolation under 60 s, and red dots depict failure to isolate under 60 s with electrogram monitoring.
Figure 6
Figure 6
Multivariable linear regression model for nadir temperature.
See this image and copyright information in PMC

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