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Time to –30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation
, 3, 1, 4, 5, 67, 8, 9, 10, 11, 1213, 14, 1516, 17, 18, 1
Affiliations- Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain
- Cardiology Department, University Hospital Torrejón, Spain
- School of Psychology. Universidad Autónoma de Madrid, Spain
- Hospital Clínico Universitario, Virgen de la V ictoria, Málaga, Spain;
- University Hospital Puerta de Hier ro, Majadahonda, Madrid, Spain
- Basurto University Hospital, Bilbao, Spain
- Clínica IMQ Zorrotzaurre, Bilbao, Spain
- Hospital Universitario Son Espases, Palma, Spain
- Córdoba Hospital Universitario Reina Sofía, Córdoba, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Ar rixaca, Murcia, Spain
- Juan Ramón Jiménez Hospital, Huelva, Spain
- HospitHospital Clínico Universitario de Valencia, Valencia, Spain
- Hospital Quiron Valencia, Valencia, Spain
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain
- Hospital Universitario Vírgen Macarena, Sevilla, Spain
- Hospital Nisa Aljarafe, Sevilla, Spain
- Araba Hospital, Vitoria, Spain
- Alicante University Genaral Hospital, Alicante, Spain
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Abstract
Background: Freezing rate of second-generation cryoballoon (CB) is a biophysical parameter that
could assist pulmonary vein isolation. The aim of this study is to assess freezing rate (time to reach
–30°C ([TT-30C]) as an early predictor of acute pulmonary vein isolation using the CB.
Methods: Biophysical data from CB freeze applications within a multicenter, nation-wide CB ablation
registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein
isolation. And SA with time to isolation under 60 s (SA-TTI<60) as achieving durable vein isolation in
under 60 s. Logistic regressions were performed and predictive models were built for the data set.
Results: 12,488 CB applications from 1,733 atrial fibrillation (AF) ablation procedures were included
within 27 centers from a Spanish CB AF ablation registry. SA was achieved in 6,349 of 9,178 (69.2%)
total freeze applications, and SA-TTI<60 was obtained in 2,673 of 4,784 (55.9%) freezes where electrogram
monitoring was present. TT-30C was shorter in the SA group (33.4 ± 9.2 vs 39.3 ± 12.1 s;
p < 0.001) and SA-TTI<60 group (31.8 ± 7.6 vs. 38.5 ± 11.5 s; p < 0.001). Also, a 10 s increase in
TT-30C was associated with a 41% reduction in the odds for an SA (odds ratio [OR] 0.59; 95% confidence
interval [CI] 0.56–0.63) and a 57% reduction in the odds for achieving SA-TTI<60 (OR 0.43;
95% CI 0.39–0.49), when corrected for electrogram visualization, vein position, and application order.
Conclusions: Time to reach –30°C is an early predictor of the quality of a CB application and can be
used to guide the ablation procedure even in the absence of electrogram monitoring.
Abstract
Background: Freezing rate of second-generation cryoballoon (CB) is a biophysical parameter that
could assist pulmonary vein isolation. The aim of this study is to assess freezing rate (time to reach
–30°C ([TT-30C]) as an early predictor of acute pulmonary vein isolation using the CB.
Methods: Biophysical data from CB freeze applications within a multicenter, nation-wide CB ablation
registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein
isolation. And SA with time to isolation under 60 s (SA-TTI<60) as achieving durable vein isolation in
under 60 s. Logistic regressions were performed and predictive models were built for the data set.
Results: 12,488 CB applications from 1,733 atrial fibrillation (AF) ablation procedures were included
within 27 centers from a Spanish CB AF ablation registry. SA was achieved in 6,349 of 9,178 (69.2%)
total freeze applications, and SA-TTI<60 was obtained in 2,673 of 4,784 (55.9%) freezes where electrogram
monitoring was present. TT-30C was shorter in the SA group (33.4 ± 9.2 vs 39.3 ± 12.1 s;
p < 0.001) and SA-TTI<60 group (31.8 ± 7.6 vs. 38.5 ± 11.5 s; p < 0.001). Also, a 10 s increase in
TT-30C was associated with a 41% reduction in the odds for an SA (odds ratio [OR] 0.59; 95% confidence
interval [CI] 0.56–0.63) and a 57% reduction in the odds for achieving SA-TTI<60 (OR 0.43;
95% CI 0.39–0.49), when corrected for electrogram visualization, vein position, and application order.
Conclusions: Time to reach –30°C is an early predictor of the quality of a CB application and can be
used to guide the ablation procedure even in the absence of electrogram monitoring.
Keywords
cryoballoon ablation, second-generation cryoballoon, pulmonary vein isolation, atrial fibrillation, atrial fibrillation ablation
About this articleTitle
Time to –30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation
Journal
Issue
Article type
Original Article
Pages
534-542
Published online
2021-10-25
Page views
2274
Article views/downloads
490
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(4):534-542.
Keywords
cryoballoon ablation
second-generation cryoballoon
pulmonary vein isolation
atrial fibrillation
atrial fibrillation ablation
Authors
Carlos Antonio Álvarez-Ortega
Miguel Angel Ruiz
César Solórzano-Guillén
Alberto Barrera
Jorge Toquero-Ramos
Jesús Daniel Martínez-Alday
Carlos Grande
José María Segura
Arcadio García-Alberola
Pablo Moriña-Vázquez
Ángel Ferrero-de-Loma-Osorio
Roger Villuendas
Rocío Cózar
Maria Fe Arcocha
Alicia Ibañez
Rafael Peinado
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