Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence.

Autor: Chahine Y; Division of Cardiology, University of Washington, Seattle, WA, USA., Afroze T; Division of Cardiology, University of Washington, Seattle, WA, USA., Bifulco SF; Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA., Macheret F; Division of Cardiology, University of Washington, Seattle, WA, USA., Abdulsalam N; Division of Cardiology, University of Washington, Seattle, WA, USA., Boyle PM; Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA.; Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA., Akoum N; Division of Cardiology, University of Washington, Seattle, WA, USA. nakoum@cardiology.washington.edu.; Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA. nakoum@cardiology.washington.edu.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2023 Sep; Vol. 66 (6), pp. 1367-1373. Date of Electronic Publication: 2022 Nov 24.
DOI: 10.1007/s10840-022-01429-0
Abstrakt: Background: Cryoballoon ablation (CBA) is an established approach for rhythm management of atrial fibrillation (AF). We sought to assess balloon temperature (BT) parameters as predictors of pulmonary vein (PV) reconnection within the index procedure and AF recurrence following CBA.
Methods: BT was monitored in 119 AF patients undergoing CBA. PVs were assessed for reconnection during the procedure and patients were followed for arrhythmia recurrence.
Results: PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of PV reconnection (30 s: - 33.5 °C [- 36; - 30] vs - 29.5 °C [- 35; - 25.5], p = 0.001; 60 s: - 41 °C [- 44; - 37] vs - 36.5 °C [- 42; - 33.5], p < 0.001; nadir: - 47 °C [- 52; - 43] vs - 41.5 °C [- 47; - 38], p < 0.001). PV reconnection was associated with significantly longer time to reach - 15 °C and - 40 °C (14.5 s [11.5-18.5] vs 12 s [10-15.5], p = 0.023; and 75 s [40-95.5] vs 46 s [37-66.75], p = 0.005) and shorter rewarming time (5.75 s [4.75-8.5] vs 7 s [6-9], p = 0.012). ROC analysis of these procedural parameters had an AUC = 0.71 in predicting PV reconnection. AF recurrence occurred in 51 (42.8%) patients. Kaplan-Meier analysis showed better arrhythmia-free survival for patients in whom BT decreased below - 40 °C in all PVs and patients who had no early PV reconnections, compared to patients in whom BT below - 40 °C was not achieved in at least one PV (log rank = 6.3, p = 0.012) and patients who had PV reconnections (log rank = 4.1, p = 0.043).
Conclusions: Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. Absence of early PV reconnections and BT dropping below - 40 °C in all PVs during CBA are associated with lower rates of AF recurrence.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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