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Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence

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Abstract

Background

Cryoballoon ablation (CBA) is an established approach for rhythm management of atrial fibrillation (AF). We sought to assess balloon temperature (BT) parameters as predictors of pulmonary vein (PV) reconnection within the index procedure and AF recurrence following CBA.

Methods

BT was monitored in 119 AF patients undergoing CBA. PVs were assessed for reconnection during the procedure and patients were followed for arrhythmia recurrence.

Results

PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of PV reconnection (30 s: − 33.5 °C [− 36; − 30] vs − 29.5 °C [− 35; − 25.5], p = 0.001; 60 s: − 41 °C [− 44; − 37] vs − 36.5 °C [− 42; − 33.5], p < 0.001; nadir: − 47 °C [− 52; − 43] vs − 41.5 °C [− 47; − 38], p < 0.001). PV reconnection was associated with significantly longer time to reach − 15 °C and – 40 °C (14.5 s [11.5–18.5] vs 12 s [10–15.5], p = 0.023; and 75 s [40–95.5] vs 46 s [37–66.75], p = 0.005) and shorter rewarming time (5.75 s [4.75–8.5] vs 7 s [6–9], p = 0.012). ROC analysis of these procedural parameters had an AUC = 0.71 in predicting PV reconnection. AF recurrence occurred in 51 (42.8%) patients. Kaplan–Meier analysis showed better arrhythmia-free survival for patients in whom BT decreased below – 40 °C in all PVs and patients who had no early PV reconnections, compared to patients in whom BT below – 40 °C was not achieved in at least one PV (log rank = 6.3, p = 0.012) and patients who had PV reconnections (log rank = 4.1, p = 0.043).

Conclusions

Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. Absence of early PV reconnections and BT dropping below – 40 °C in all PVs during CBA are associated with lower rates of AF recurrence.

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Acknowledgements

We acknowledge the tremendous support of the Division of Cardiology Section of Electrophysiology and the Department of Bioengineering at the University of Washington.

Funding

This work was supported by the John Locke Charitable Trust to NA.

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Authors and Affiliations

  1. Division of Cardiology, University of Washington, Seattle, WA, USA

    Yaacoub Chahine, Tanzina Afroze, Fima Macheret, Nashwa Abdulsalam & Nazem Akoum

  2. Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Savannah F. Bifulco, Patrick M. Boyle & Nazem Akoum

  3. Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA

    Patrick M. Boyle

  4. Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA

    Patrick M. Boyle

Authors
  1. Yaacoub Chahine
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  2. Tanzina Afroze
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  4. Fima Macheret
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  5. Nashwa Abdulsalam
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  6. Patrick M. Boyle
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  7. Nazem Akoum
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Corresponding author

Correspondence to Nazem Akoum.

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Access to patient information was approved by the Institutional Review Board (IRB) of the University of Washington.

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All participants provided verbal consent (HSD#6058) for use of their anonymized clinical data for research purposes.

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The authors declare no competing interests.

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Chahine, Y., Afroze, T., Bifulco, S.F. et al. Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence. J Interv Card Electrophysiol 66, 1367–1373 (2023). https://doi.org/10.1007/s10840-022-01429-0

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  • DOI: https://doi.org/10.1007/s10840-022-01429-0

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