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
. 2022 Apr 27:40:101040.
doi: 10.1016/j.ijcha.2022.101040. eCollection 2022 Jun.

Durability of pulmonary vein isolation following cryoballoon ablation: Lessons from a large series of repeat ablation procedures

Giacomo Mugnai  1   2 , Federico Cecchini  1   3 , Erwin Stroker  1 , Gaetano Paparella  1 , Saverio Iacopino  1 , Juan Sieira  1 , Yves De Greef  3 , Luca Tomasi  2 , Bruna Bolzan  2 , Gezim Bala  1 , Ingrid Overeinder  1 , Alexandre Almorad  1 , Anais Gauthey  1 , Antonio Sorgente  1 , Flavio Luciano Ribichini  2 , Carlo de Asmundis  1 , Gian-Battista Chierchia  1
Affiliations

Durability of pulmonary vein isolation following cryoballoon ablation: Lessons from a large series of repeat ablation procedures

Giacomo Mugnai et al. Int J Cardiol Heart Vasc. .

Abstract

Introduction: The second-generation cryoballoon (CB) has emerged in the last decade as an effective treatment for atrial fibrillation (AF). This study sought to analyze the rate of PV reconnection following CB ablation, evaluate the most frequent PV sites of conduction recovery and finally to assess procedural and biophysical indicators of reconnection in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias.

Methods and results: A total of 300 consecutive patients (189 males, 63%; mean age 63.0 ± 11.1 years) underwent a repeat ablation after 18.2 ± 10.8 months from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 1178 PVs, 209 (17.7%) showed a late PV reconnection in 177 patients (1.18 per patient), at the time of repeat ablation procedure. Overall, persistent PV isolation could be documented in 969 of 1178 PVs (82.3%). In 123 of 300 patients (41%), persistent isolation could be demonstrated in all PVs, whereas PV reconnection could be documented in 177 patients (59%). In the multivariable analysis, nadir temperature (p = 0.03), time to PV isolation (p = 0.01) and failure to achieve - 40 °C within 60 s (p = 0.05) were independently associated with late PV reconnection.

Conclusions: The rate of late PV reconnection after CB ablation was low (1.18 PVs/patient). The most frequent sites of reconnections were the superior-anterior portions for the upper PVs and the inferior-posterior portions for the lower PVs. Faster time to isolation, colder nadir temperatures and achievement of - 40 °C within 60 s were associated with durable PV isolation.

Keywords: Conduction gaps; Cryoballoon; Pulmonary vein isolation; Reconnections.

PubMed Disclaimer

Conflict of interest statement

GBC reports speaker fees for Medtronic, Biotronik, Biosense Webster, and Abbott; teaching honoraria from Medtronic and Biotronik; proctoring honoraria from Medtronic; C.d.A. reports speaker fees for Medtronic, Biotronik, Biosense Webster, Abbott, and Boston Scientific; teaching honoraria from Medtronic, Biotronik, Abbott, and Boston Scientific; proctoring honoraria from Medtronic, Abbott, and Biotronik. Funding: research support from the Heart Rhythm Research Center.

Figures

Fig. 1
Fig. 1
Distribution of reconducting gaps (blue dots) after second-generation CB ablation. The size of blue dots is related to the frequency of reconnection for that specific site. The red star indicates carina. The green star indicates the ridge between the ostium of LSPV and the left atrial appendage. PV: pulmonary vein. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

References

    1. Lee G., Sanders P., Kalman J.M. Catheter ablation of atrial arrhythmias : state of the art. Lancet. 2012;380:1509–1519. - PubMed
    1. Kuck K.H., Brugada J., Furnkranz A., Metzner A., Ouyang F., Chun K.R., Elvan A., Arentz T., Bestehorn K., Pocock S.J., Albenque J.P., Tondo C., FIRE AND ICE Investigators Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374:2235–2245. - PubMed
    1. Velagic V., Prepolec I., Pasara V., Puljevic M., Puljevic D., Planinc I., Samardzic J., Milicic D. Learning curves in atrial fibrillation ablation-A comparison between second generation cryoballoon and contact force sensing radiofrequency catheters. Indian Pacing Electrophysiol J. 2020;20(6):273–280. - PMC - PubMed
    1. Fürnkranz A., Bordignon S., Schmidt B., Gunawardene M., Schulte-Hahn B., Urban V., Bode F., Nowak B., Chun J.K. Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol. 2013;24(5):492–497. - PubMed
    1. Di Giovanni G., Wauters K., Chierchia G.B., Sieira J., Levinstein M., Conte G., de Asmundis C., Baltogiannis G., Saitoh Y., Ciconte G., Julia J., Mugnai G., Irfan G., Brugada P. One-year follow-up after single procedure cryoballoon ablation: a comparison between the first and second generation balloon. J Cardiovasc Electrophysiol. 2014;25(8):834–839. - PubMed