Key result
Sinus rhythm during cryoballoon ablation predicted a significantly higher real-time observation rate of time-to pulmonary vein isolation compared to atrial fibrillation (86.3% vs 75.5%; p<0.001).
Why the study?
It was unknown whether correct pulmonary vein electrogram interpretation and real-time observation rate of pulmonary vein isolation depend on atrial rhythm during cryoballoon ablation.
Does performing cryoballoon ablation during sinus rhythm improve the real-time observation rate of time-to pulmonary vein isolation compared to atrial fibrillation in patients undergoing PVI?
Observational (n=157)
Does performing cryoballoon ablation during sinus rhythm improve the real-time observation rate of time-to pulmonary vein isolation compared to atrial fibrillation in patients undergoing PVI?
Performing cryoballoon ablation during sinus rhythm rather than atrial fibrillation significantly increases the ability to observe real-time pulmonary vein isolation, facilitating cryoenergy titration.
Associated with higher real-time PVI observation in sinus rhythm; hypothesis-generating for rhythm-targeted strategies in prospective trials.
PURPOSE: Real-time observation of pulmonary vein (PV) potentials with a spiral mapping catheter has emerged as a key electrogram-based procedural parameter to estimate lesion quality and titrate cryoenergy application during PV isolation (PVI) with the cryoballoon. Whether correct PV electrogram interpretation and thus PVI real-time observation rate depends on atrial rhythm during cryoballoon PVI is unknown. We compared observation rates of time-to PV isolation (TTI) during sinus rhythm (SR group) and during atrial fibrillation (AFib group) in cryoballoon PVI. METHODS: We prospectively included 157 consecutive patients undergoing cryoballoon PVI and compared the incidence of PVI real-time recording of each pulmonary vein during SR and in AFib. RESULTS: Overall PVI real-time observation rate was 82.1% (491/598 PV) with significantly higher TTI observation rate in the SR group (315/365 PV, 86.3%) compared to the AFib group (176/233 PV, 75.5%; p < 0.001). Per vein analysis demonstrated that only TTI observation rate in the left superior pulmonary vein (LSPV) was significantly higher during SR (85/92, 92.4%) compared to AFib (37/54, 68.5%; p < 0.001). Regression analysis revealed that atrial rhythm is a strong and independent predictor of PVI real-time observation in the LSPV with an odds ratio of 4.98 (95%-CI: 1.86-13.34, p = 0.001) to detect TTI during SR. CONCLUSIONS: Our results demonstrate that correct interpretation of PV electrograms and thus PVI real-time observation is more likely in SR than in AFib. Hence, cardioversion of patients in AFib at the beginning of the procedure should be considered to yield higher PVI real-time observation rates facilitating TTI guided cryoenergy titration.
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Pott et al. (2019) conducted an observational in Atrial fibrillation undergoing cryoballoon pulmonary vein isolation (n=157). Sinus rhythm vs. Atrial fibrillation was evaluated on Real-time observation rate of time-to pulmonary vein isolation (OR 4.98, 95% CI 1.86-13.34, p=<0.001). Sinus rhythm during cryoballoon ablation predicted a significantly higher real-time observation rate of time-to pulmonary vein isolation compared to atrial fibrillation (86.3% vs 75.5%; p<0.001).
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