Key result
Complete PV occlusion during cryoballoon ablation predicts ~393% greater odds of persistent PVI.
Why the study?
The effect of procedural characteristics of cryoballoon-based pulmonary vein isolation on late pulmonary vein reconnections in atrial fibrillation patients was unclear.
Does complete pulmonary vein occlusion during cryoballoon ablation prevent late pulmonary vein reconnections in patients with drug-refractory atrial fibrillation?
Observational (n=45)
Single-blind (observers evaluating occlusion grade were blinded)
No
Does complete pulmonary vein occlusion during cryoballoon ablation prevent late pulmonary vein reconnections in patients with drug-refractory atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Achieving complete pulmonary vein occlusion (grade 4) during index cryoballoon ablation is a strong independent predictor of long-term pulmonary vein isolation durability.
BACKGROUND: Pulmonary vein isolation (PVI) using a cryoballoon (CB) is utilized for treating atrial fibrillation. This study aimed to assess the effect of the procedural characteristics of CB-based PVI (CB-PVI) on late PV reconnections. METHODS AND RESULTS: A total of 389 consecutive patients underwent the CB-PVI as their index procedure; 45 consecutive patients underwent re-do procedures (184±87 days after the index CB-PVI). A total of 146 of 178 PVs (82%) remained isolated. The occlusion grade was evaluated in 171 PVs. Complete PV occlusion by the CB (grade 4) was obtained in 122 of 171 PVs (71%) during the index CB-PVI and the PVI status was maintained in 111 PVs (91%). Among the remaining 49 CB-PVIs without complete PV occlusion (grades 1-3), 20 PVs (41%) had late PV reconnections despite successful PVI during the index CB-PVI. A "pull-down maneuver" was performed in 20 PVs because of leakage of blood at the inferior aspect of the PVs, and all those PVs with a successful pull-down maneuver maintained their PVI status. A multivariate analysis demonstrated that the presence of complete PV occlusion was the only independent predictor for persistence of PVI. CONCLUSIONS: The occlusion grade was a reliable predictor of the long-term durability of PVI.
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Kawaguchi et al. (2017) conducted an observational in Drug-refractory atrial fibrillation (n=45). Complete pulmonary vein occlusion (occlusion grade 4) vs. Absence of complete pulmonary vein occlusion (occlusion grades 1-3) was evaluated on Persistent pulmonary vein isolation status during re-do procedure (OR 4.93, 95% CI 1.98-12.3, p=<0.001). Complete pulmonary vein occlusion during the index cryoballoon ablation was the only independent predictor of persistent pulmonary vein isolation (OR 4.93).
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