PolarX Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation.

Autor:	Honarbakhsh S; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Earley MJ; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Martin CA; Royal Papworth Hospital, Cambridge, UK., Creta A; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Sohaib A; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Ang R; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Butcher C; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Waddingham PH; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Dhinoja M; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Lim W; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK., Srinivasan NT; Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, CM1 1SQ Chelmsford, UK., Providencia R; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Kanthasamy V; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Sporton S; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Chow A; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Lambiase PD; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Schilling RJ; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Finlay MC; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK., Hunter RJ; The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2022 Oct 13; Vol. 24 (9), pp. 1420-1429.
DOI:	10.1093/europace/euac100
Abstrakt:	Aim: Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon. Methods and Results: This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different. Conclusions: The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required. Competing Interests: Conflict of interest: R.J.S. has received speaker and travel grants from Biosense Webster and research grants from Biosense Webster. R.J.H. has received travel grants for the purposes of attending conferences from Biosense Webster. P.D.L. receives research grants from Medtronic, Abbott, and Boston Scientific. M.C.F. receives speaker fees and advisory board fees from Boston Scientific, Abbott, and Biosense Webster and research support from Abbott. R.J.H., R.J.S., M.C.F., and S.H. are inventors of the STAR Mapping system and Founders of Rhythm AI. C.A.M. has received research grants and consultancy fees from Boston Scientific and speaker and travel grants from Boston Scientific and Medtronic. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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