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. 2023 Dec;66(9):2091-2101.
doi: 10.1007/s10840-023-01538-4. Epub 2023 Apr 17.

The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection : Insights from the Middelheim-PVI Registry 2

Y De Greef  1   2 , D Sofianos  3 , M Tijskens  4 , B Schwagten  4 , M Wolf  4 , I Buysschaert #  5 , J P Abugattas #  6
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The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection : Insights from the Middelheim-PVI Registry 2

Y De Greef et al. J Interv Card Electrophysiol. 2023 Dec.

Abstract

Background: Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15-40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI. Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI.

Methods: Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (N = 252 [31.4%]), 1 (N = 255 [31.8%]), 2 (N = 159 [19.8%]), and 3-4 (N = 137 [17.1]).

Results: At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134-1.433; p < 0.01), independent of persistent AF type (HR = 2.075; 95% CI 1.584-2.738; p < 0.01), left atrial diameter (HR = 1.050; 95% CI 1.028-1.072; p < 0.01), and diagnosis-to-ablation time (HR = 1.002; 95% CI 1.000-1.005; p = 0.04). Highest success was achieved with present real-time PVI in all veins (77.4%), gradually decreasing per increasing number of absent real-time PVI: 66.3% for 1 vein, 58.5% for 2, and 48.9% for 3-4 veins (p < 0.001). At repeat ablation (N = 188), PV reconnection was seen in 99/430 (23.0%) versus 83/288 (28.8%) veins with and without real-time PVI, respectively (p = 0.08). Right inferior PVs (RIPVs) with real-time PVI were less reconnected than RIPVs without real-time PVI: 29.7% versus 43.7% (p = 0.047).

Conclusion: The absence of real-time PVI during CBA independently predicts AF recurrence with a 30% gradual decrease in outcome per increase in veins without real-time PVI. Real-time PVI is particularly important for the RIPV to achieve durable PVI.

Keywords: Atrial fibrillation; Cryoballoon ablation; Pulmonary vein isolation; Real-time PVI.

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References

    1. Heeger CH, Wissner E, Knoll M, Knoop B, Reissmann B, Mathew S, et al. Three year clinical outcome after 2nd-generation cryoballoon-based pulmonary vein isolation for the treatment of paroxysmal and persistent atrial fibrillation - a 2-center experience. Circ J. 2017;81:974–80. - DOI - PubMed
    1. Furnkranz A, Bordignon S, Schmidt B, Gunawardene M, Schulte-Hahn B, Urban V, et al. Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol. 2013;24:492–7. - DOI - PubMed
    1. Boveda S, Providência R, Albenque JP, Combes N, Combes S, Hireche H, et al. Real-time assessment of pulmonary vein disconnection during cryoablation of atrial fibrillation: can it be ‘achieved’ in almost all cases? Europace. 2014;16:826–33. - DOI - PubMed
    1. Yokoyama K, Tokuda M, Matsuo S, Isogai R, Tokutake K, Kato M, et al. Pulmonary vein remapping after cryoballoon ablation for atrial fibrillation. Europace. 2018;20:943–8. - DOI - PubMed
    1. Conte G, Soejima K, de Asmundis C, Chierchia GB, Badini M, Miwa Y, et al. Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation. Int J Cardiol. 2018;270:136–42. - DOI - PubMed

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