• Heart and vessels · Jan 2020

    Circulatory dynamics changes are an additional predictor of successful pulmonary vein isolation during cryoballoon ablation.

    • Takatsugu Kajiyama, Shinsuke Miyazaki, Rikuta Hamaya, Tomonori Watanabe, Kazuya Yamao, Shigeki Kusa, Miyako Igarashi, Hiroaki Nakamura, Hitoshi Hachiya, and Yoshito Iesaka.
    • Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 4-1-1 Otsuno, Tsuchiura, 300-0028, Ibaraki, Japan. tak4poincar@gmail.com.
    • Heart Vessels. 2020 Jan 1; 35 (1): 125-131.

    AbstractThe association between circulatory dynamics changes during cryoballoon applications and a successful pulmonary vein isolation (PVI) is unknown. Seventy atrial fibrillation patients who underwent PVI with 28-mm second-generation cryoballoons and single 3-min freezes were included. Intra-procedural parameters including circulatory dynamics changes during cryoapplications, were compared between 113 successful applications (30 left superior PVs[LSPVs], 30 left inferior PVs[LIPVs], 25 right superior PVs[RSPVs], and 28 right inferior PVs[RIPVs]) and 47 failed applications (10 LSPVs, 9 LIPVs, 8 RSPVs, and 20 RIPVs). In all individual PVs, lower nadir balloon temperatures (MinTemps) and longer thawing times (ThawTimes) significantly predicted a successful PVI. In addition, greater systolic blood pressure drops following releasing the PV occlusion (SBP-drops) significantly predicted a successful right PV PVI, and longer elapse times during SBP-drops significantly predicted a successful RIPV PVI. Composite parameters incorporating MinTemps and ThawTimes, SBP-drops, and ThawTimes showed the highest area under the curve to predict a successful left PV (0.876 for LSPVs, 0.851 for LIPVs) and right PV (0.927 for RSPVs, 0.980 for RIPVs) PVI, respectively. If the ThawTime (≥ 30 s) and SBP-drop (≤ - 21 mmHg) cutoff values were achieved for the RIPVs, the positive predictive value was 100%. In contrast, if both criteria were not achieved for the RIPVs, the negative predictive value was 100%. In the second-generation cryoballoon PVI, the MinTemp and ThawTime were significantly associated with acute success for all four PVs. In addition, SBP-drops further improved the accuracy of predicting a successful right PV PVI, especially of the RIPV.

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