The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon

Autor: Norbert Güttler, Malte Kuniss, Ersan Akkaya, Thomas Neumann, Andreas Hain, Harald Greiss, Sergey Zaltsberg, N Deubner, Alexander Berkowitsch
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Catheter ablation
030204 cardiovascular system & hematology
Cryosurgery
Cardiac Catheters
Pulmonary vein
03 medical and health sciences
0302 clinical medicine
Peripheral Nerve Injuries
Risk Factors
Physiology (medical)
Internal medicine
Atrial Fibrillation
Occlusion
Linear regression
medicine
Humans
030212 general & internal medicine
Aged
Retrospective Studies
Chi-Square Distribution
business.industry
Atrial fibrillation
Cryoablation
Equipment Design
Middle Aged
medicine.disease
Surgery
Cold Temperature
Phrenic Nerve
Logistic Models
Treatment Outcome
ROC Curve
Pulmonary Veins
Area Under Curve
Linear Models
Cardiology
Female
Patient Safety
Analysis of variance
Cardiology and Cardiovascular Medicine
business
Nadir (topography)
Zdroj: EP Europace. 19:1470-1477
ISSN: 1532-2092
1099-5129
DOI: 10.1093/europace/euw192
Popis: Aims There is no objective, early indicator of occlusion quality, and efficacy of cryoballoon pulmonary vein isolation. As previous experience suggests that the initial cooling rate correlates with these parameters, we investigated the slope of the initial temperature drop as an objective measure. Methods and results A systematic evaluation of 523 cryoapplications in 105 patients using a serial ROC-AUC analysis was performed. We found the slope of a linear regression of the temperature–time function to be a good predictor (PPV 0.9, specificity 0.72, sensitivity 0.71, and ROC-AUC 0.75) of acute isolation. It also correlated with nadir temperatures ( P < 0.001, adjusted R 2= 0.43), predicted very low nadir temperatures, and varied according to visual occlusion grades (ANOVA P < 0.001). Conclusions About 25 s after freeze initiation, the temperature–time slope predicts important key characteristics of a cryoablation, such as nadir temperature. The slope is the only reported predictor to actually precede acute isolation and thus to support decisions about pull-down manoeuvres or aborting a cryoablation early on. It is also predictive of very low nadir temperatures and phrenic nerve palsy and thus may add to patient safety.
Databáze: OpenAIRE
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