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Circulatory dynamics changes are an additional predictor of successful pulmonary vein isolation during cryoballoon ablation

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Abstract

The association between circulatory dynamics changes during cryoballoon applications and a successful pulmonary vein isolation (PVI) is unknown. Seventy atrial fibrillation patients who underwent PVI with 28-mm second-generation cryoballoons and single 3-min freezes were included. Intra-procedural parameters including circulatory dynamics changes during cryoapplications, were compared between 113 successful applications (30 left superior PVs[LSPVs], 30 left inferior PVs[LIPVs], 25 right superior PVs[RSPVs], and 28 right inferior PVs[RIPVs]) and 47 failed applications (10 LSPVs, 9 LIPVs, 8 RSPVs, and 20 RIPVs). In all individual PVs, lower nadir balloon temperatures (MinTemps) and longer thawing times (ThawTimes) significantly predicted a successful PVI. In addition, greater systolic blood pressure drops following releasing the PV occlusion (SBP-drops) significantly predicted a successful right PV PVI, and longer elapse times during SBP-drops significantly predicted a successful RIPV PVI. Composite parameters incorporating MinTemps and ThawTimes, SBP-drops, and ThawTimes showed the highest area under the curve to predict a successful left PV (0.876 for LSPVs, 0.851 for LIPVs) and right PV (0.927 for RSPVs, 0.980 for RIPVs) PVI, respectively. If the ThawTime (≥ 30 s) and SBP-drop (≤ − 21 mmHg) cutoff values were achieved for the RIPVs, the positive predictive value was 100%. In contrast, if both criteria were not achieved for the RIPVs, the negative predictive value was 100%. In the second-generation cryoballoon PVI, the MinTemp and ThawTime were significantly associated with acute success for all four PVs. In addition, SBP-drops further improved the accuracy of predicting a successful right PV PVI, especially of the RIPV.

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Acknowledgements

We would like to thank Mr. John Martin for his help in the preparation of the manuscript.

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Authors and Affiliations

  1. Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 4-1-1 Otsuno, Tsuchiura, 300-0028, Ibaraki, Japan

    Takatsugu Kajiyama, Rikuta Hamaya, Tomonori Watanabe, Kazuya Yamao, Shigeki Kusa, Miyako Igarashi, Hiroaki Nakamura, Hitoshi Hachiya & Yoshito Iesaka

  2. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Shinsuke Miyazaki

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  1. Takatsugu Kajiyama
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  2. Shinsuke Miyazaki
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  3. Rikuta Hamaya
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  4. Tomonori Watanabe
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  5. Kazuya Yamao
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  8. Hiroaki Nakamura
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  9. Hitoshi Hachiya
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  10. Yoshito Iesaka
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Correspondence to Takatsugu Kajiyama.

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Kajiyama, T., Miyazaki, S., Hamaya, R. et al. Circulatory dynamics changes are an additional predictor of successful pulmonary vein isolation during cryoballoon ablation. Heart Vessels 35, 125–131 (2020). https://doi.org/10.1007/s00380-019-01467-1

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  • DOI: https://doi.org/10.1007/s00380-019-01467-1

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