Key result
Electrical pulmonary vein reconnection occurred in 85% of patients after second-generation cryoballoon ablation and 91% after first-generation, with the right inferior PV predicting reconnection.
Why the study?
What are the predilection sites and predictors of electrical pulmonary vein reconnection in patients with recurrent atrial tachyarrhythmia after pulmonary vein isolation using first- and second-generation cryoballoons?
Observational (n=59)
What are the predilection sites and predictors of electrical pulmonary vein reconnection in patients with recurrent atrial tachyarrhythmia after pulmonary vein isolation using first- and second-generation cryoballoons?
Absolute Event Rate: 85% vs 91%
Following cryoballoon pulmonary vein isolation, conduction gaps are most common in the inferior pulmonary veins, with minimum temperature and the right inferior pulmonary vein being independent predictors of reconnection for second-generation devices.
Reconnection sites and predictors after cryoballoon PVI identified in recurrent ATa; leaves open targeted durability strategies pending prospective validation.
BACKGROUND: Second-generation cryoballoon (CB-2) is associated with improved outcomes for pulmonary vein isolation (PVI) compared to first generation (CB-1). However, data regarding the predictors of pulmonary vein (PV) electrical reconnection are limited. In this study, we aimed to characterize the predilection sites and predictors of reconnection in patients with recurrent atrial tachyarrhythmia (ATa) after PVI using CB-1 and CB-2. METHODS: A total of 59 patients (mean age: 62 ± 11 years and 66% male) with recurrent ATa after previous CB-PVI, using either a 28-mm CB-1 or CB-2, underwent repeat ablation. PV reisolation was performed by irrigated radiofrequency ablation using three-dimensional electroanatomical mapping systems. RESULTS: Electrical PV reconnection was detected in 10 of 11 (91%) of CB-1 patients compared to 41 of 48 (85%) of CB-2 patients. Time to redo procedure after index CB-1 was 8.9 ± 10.2 months and 11.2 ± 7.0 months in CB-2. Bonus freeze was applied in all patients with CB-1 and 41% of the patients with CB-2. Superior quadrants of both superior PVs and inferior quadrants of the both inferior PVs exhibited higher predilection for conduction compared to other quadrants (P < 0.001). Multivariate binary logistic analysis revealed that right inferior PV (RIPV; odds ratio [OR]: 1.52, 95% confidence interval [CI]: 1.09-2.13, P = 0.014) and minimum temperature (OR: 1.09, 95% CI: 1.03-1.15, P = 0.004) were the independent predictors of electrical reconnection after CB-2 ablation. CONCLUSION: Conduction gaps after CB-1 and CB-2 were higher in inferior PVs compared to superior PVs. The RIPV and minimum CB temperature were independent predictors of PV electrical reconnection after CB-2.
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Koektuerk et al. (2016) conducted an observational in Recurrent atrial tachyarrhythmia after previous pulmonary vein isolation (n=59). Second-generation cryoballoon (CB-2) vs. First-generation cryoballoon (CB-1) was evaluated on Electrical pulmonary vein reconnection. Electrical pulmonary vein reconnection occurred in 85% of patients after second-generation cryoballoon ablation and 91% after first-generation, with the right inferior PV predicting reconnection.
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