Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters

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

Heart Rhythm O2 (Jun 2021)

Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters

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

Affiliations

Fehmi Keçe, MD, PhD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
Marta de Riva, MD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
Reza Alizadeh Dehnavi, MD, PhD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
Adrianus P. Wijnmaalen, MD, PhD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
Bart J. Mertens, PhD: Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands
Martin J. Schalij, MD, PhD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
Katja Zeppenfeld, MD, PhD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
Serge A. Trines, MD, PhD: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Address reprint requests and correspondence: Dr Serge A. Trines, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Journal volume & issue: Vol. 2, no. 3
pp. 290 – 297

Abstract

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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.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

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