• Circ Arrhythm Electrophysiol · Dec 2015

    On the Quest for the Best Freeze: Predictors of Late Pulmonary Vein Reconnections After Second-Generation Cryoballoon Ablation.

    • Giuseppe Ciconte, Giacomo Mugnai, Juan Sieira, Vedran Velagić, Yukio Saitoh, Ghazala Irfan, Burak Hunuk, Erwin Ströker, Giulio Conte, Giacomo Di Giovanni, Giannis Baltogiannis, Kristel Wauters, Pedro Brugada, Carlo de Asmundis, and Gian-Battista Chierchia.
    • From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium. g.ciconte@gmail.com.
    • Circ Arrhythm Electrophysiol. 2015 Dec 1; 8 (6): 1359-65.

    BackgroundThe second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation.Methods And ResultsA total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5-19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI (P=0.03) and failure to achieve -40°C within 60 s (P=0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73-0.97; P<0.001).ConclusionsThe rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of -40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.© 2015 American Heart Association, Inc.

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