• Int. J. Cardiol. · Feb 2020

    Predictors of durable pulmonary vein isolation after second-generation cryoballoon ablation with a single short freeze strategy - Different criteria for the best freeze of the 4 individual PVs.

    • Shinsuke Miyazaki, Takatsugu Kajiyama, Tomonori Watanabe, Hiroaki Nakamura, Hitoshi Hachiya, Hiroshi Tada, and Yoshito Iesaka.
    • Department of Cardiovascular medicine, Fukui University, Fukui, Japan. Electronic address: mshinsuke@k3.dion.ne.jp.
    • Int. J. Cardiol. 2020 Feb 15; 301: 96-102.

    BackgroundParameters predicting the second-generation cryoballoon pulmonary vein isolation (CB-PVI) durability of each individual PV have not been investigated.ObjectiveWe explored the PVI durability predictors after left superior (LS), left inferior (LI), right superior (RS), and right inferior (RI) PV CB-PVI.MethodsData from 101 consecutive patients who underwent repeat procedures 7.0 [4.5-10.0] months after index cryoballoon procedures with single short freeze strategies were analyzed.ResultsAmong 369 PVs successfully isolated by cryoballoons with mean freezing times of 207 s, 82/94 (87.2%) LSPVs, 78/93 (83.9%) LIPVs, 80/98 (81.6%) RSPVs, and 63/84 (75.0%) RIPVs were durable. In the remaining 25 PVs requiring touch-up ablation, 20 (83.3%) PVs had reconnections. In analyzing all PVs together, lower nadir balloon temperature, faster freezing speed (FS), slower thawing speed (TS), and shorter time-to-isolation were significantly associated with higher PVI durability, however, all parameters significantly differed among the 4 individual PVs (p < 0.0001). In individual analyses, for the LSPV, faster FS to -40 °C predicted higher PVI durability, but younger patients more likely had reconnections. For the LIPV, faster FS to -30 °C predicted higher PVI durability. For the RSPV, a lower nadir temperature, faster FS (to -30 and -40 °C), slower TS (to 0 and 15 °C), shorter time-to-isolation, and smaller PV diameter predicted higher PVI durability. For the RIPV, a slower TS (to 0 and 15 °C) predicted higher PVI durability.ConclusionsThe durability of the CB-PVI was high even with a single short freeze strategy. The parameters predicting the PVI durability differed among the 4 PVs, suggesting that best freeze criterion should be considered separately for each of the 4 PVs.Copyright © 2019 Elsevier B.V. All rights reserved.

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