Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters
Background: Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. Objective: To identify procedural and biophysical parameters predicting ERC. Methods: Consecutive atrial fibrillation (AF) patients u...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501821000489 |
| _version_ | 1818670359223730176 |
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| author | Fehmi Keçe, MD, PhD Marta de Riva, MD Reza Alizadeh Dehnavi, MD, PhD Adrianus P. Wijnmaalen, MD, PhD Bart J. Mertens, PhD Martin J. Schalij, MD, PhD Katja Zeppenfeld, MD, PhD Serge A. Trines, MD, PhD |
| author_facet | Fehmi Keçe, MD, PhD Marta de Riva, MD Reza Alizadeh Dehnavi, MD, PhD Adrianus P. Wijnmaalen, MD, PhD Bart J. Mertens, PhD Martin J. Schalij, MD, PhD Katja Zeppenfeld, MD, PhD Serge A. Trines, MD, PhD |
| author_sort | Fehmi Keçe, MD, PhD |
| collection | DOAJ |
| description | Background: Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. Objective: To identify procedural and biophysical parameters predicting ERC. Methods: Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. Results: A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09–1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15–2.49], P = .008) and a longer TTI (HR 1.02 [1.01–1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. Conclusion: Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing. |
| first_indexed | 2024-12-17T07:06:51Z |
| format | Article |
| id | doaj.art-75c35fd5405b4ac8b02daa740a5b2a17 |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-17T07:06:51Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-75c35fd5405b4ac8b02daa740a5b2a172022-12-21T21:59:09ZengElsevierHeart Rhythm O22666-50182021-06-0123290297Predicting early reconnection after cryoballoon ablation with procedural and biophysical parametersFehmi Keçe, MD, PhD0Marta de Riva, MD1Reza Alizadeh Dehnavi, MD, PhD2Adrianus P. Wijnmaalen, MD, PhD3Bart J. Mertens, PhD4Martin J. Schalij, MD, PhD5Katja Zeppenfeld, MD, PhD6Serge A. Trines, MD, PhD7Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The NetherlandsBioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands; Address reprint requests and correspondence: Dr Serge A. Trines, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.Background: Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. Objective: To identify procedural and biophysical parameters predicting ERC. Methods: Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. Results: A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09–1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15–2.49], P = .008) and a longer TTI (HR 1.02 [1.01–1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. Conclusion: Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing.http://www.sciencedirect.com/science/article/pii/S2666501821000489Atrial fibrillationCryoballoon ablationDormant conductionPulmonary vein isolationTime-to-isolation |
| spellingShingle | Fehmi Keçe, MD, PhD Marta de Riva, MD Reza Alizadeh Dehnavi, MD, PhD Adrianus P. Wijnmaalen, MD, PhD Bart J. Mertens, PhD Martin J. Schalij, MD, PhD Katja Zeppenfeld, MD, PhD Serge A. Trines, MD, PhD Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters Heart Rhythm O2 Atrial fibrillation Cryoballoon ablation Dormant conduction Pulmonary vein isolation Time-to-isolation |
| title | Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters |
| title_full | Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters |
| title_fullStr | Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters |
| title_full_unstemmed | Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters |
| title_short | Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters |
| title_sort | predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters |
| topic | Atrial fibrillation Cryoballoon ablation Dormant conduction Pulmonary vein isolation Time-to-isolation |
| url | http://www.sciencedirect.com/science/article/pii/S2666501821000489 |
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