• Alexander Fürnkranz, Ilka Köster, K R Julian Chun, Andreas Metzner, Shibu Mathew, Melanie Konstantinidou, Feifan Ouyang, and Karl Heinz Kuck.
• Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. a.fuernkranz@gmail.com
• Heart Rhythm. 2011 Jun 1; 8 (6): 821-5.

BackgroundCryoballoon pulmonary vein isolation (PVI) currently requires a long cryoballoon application (CBA) time of 240 to 300 seconds, thus repeated ineffective CBA prolongs procedure duration. We hypothesized that cryoballoon temperature (CBT) may be used to discriminate between effective and ineffective CBA during freezing.ObjectiveThis study sought to evaluate CBT as a predictor of CBA efficiency.MethodsSixty-six patients with atrial fibrillation underwent PVI using the single big (28 mm) cryoballoon technique. CBT was continuously recorded. After each CBA (300 seconds), a Lasso catheter (Biosense Webster, Inc., Diamond Bar, California) was placed into the target pulmonary vein (PV) to determine whether electrical PV disconnection was present. Only the first CBA at each PV was analyzed to avoid cumulative effects.ResultsThe CBT was lower during CBA at superior compared with inferior PVs. When individual CBAs were grouped according to successful/failed PVI, CBT was lower for those CBAs that resulted in successful PVI at all time points analyzed. To test the performance of CBT to predict failed CBA, receiver-operator curves were constructed. A minimal CBT of ≥ -42°C/ -39°C (superior/inferior PVs) predicted failed PVI with 73%/92% specificity (area under the curve 0.82/0.81); positive predictive value (PPV) 74%/74%. A minimal CBT of < -51°C was invariably associated with PVI. After 120 seconds of freezing, a CBT of ≥ -36°C/ -33°C (superior/inferior PVs) predicted failed PVI with 97%/95% specificity (area under the curve 0.82/0.76); PPV 82%/80%.ConclusionBalloon temperature predicts successful target PVI during cryoablation and may serve in the early identification of noneffective balloon applications.Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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