title: Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation.
abstract: BACKGROUND
  Limited data exist on procedural and biophysical indicators of pulmonary vein (PV) isolation durability after the cryoballoon ablation of atrial fibrillation (AF).
  
  
  OBJECTIVE
  The aim of this study was to investigate the procedural and biophysical characteristics associated with late PV reconnection (PVR) and durable PV isolation (PVI) after cryoablation using the currently available second-generation cryoballoon.
  
  
  METHODS
  Data from 435 PVs targeted in 112 consecutive patients who underwent a repeat procedure 14 ± 3 months after an index cryoablation of AF were examined.
  
  
  RESULTS
  Altogether, 111 PVs (25.5%) in 71 patients (63.4%) demonstrated PVR, whereas 324 PVs (74.5%) exhibited PVI. The number and duration of cryoballoon applications did not differ between PVR and PVI. However, the time to PV isolation (time to effect) was considerably shorter (39.1 ± 11.7 seconds vs 67.6 ± 19.7 seconds; P < .001), the balloon temperature at time to effect was significantly warmer (-32.1°C ± 7.8°C vs -39.4°C ± 5.8°C; P < .001), the balloon nadir temperature was slightly cooler (-48.7°C ± 4.6°C vs -47.8°C ± 2.9°C; P = .034), and the total thaw time (56.5 ± 25.4 seconds vs 34.8 ± 9.1 seconds; P < .001) and interval thaw times at 0°C (iTT0; 14.8 ± 10.9 seconds vs 7.1 ± 2.0 seconds; P < .001) and 15°C (54.2 ± 25.4 seconds vs 33.3 ± 9.1 seconds; P < .001) were notably longer with PVI than with PVR. However, only a time to effect of ≤60 seconds and an iTT0 of ≥10 seconds emerged as significant predictors of PV isolation durability. Consequently, in a multivariate model, presence of both criteria predicted <1% and their mere absence ~75% likelihood of PVR.
  
  
  CONCLUSIONS
  A time to effect of ≤60 seconds and an iTT0 of ≥10 seconds significantly predict PV isolation durability after the cryoballoon ablation of AF. If both criteria are met, the likelihood of PV reconnection may be exceedingly low.
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California. Electronic address: Arash.Aryana@DignityHealth.org.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.affiliation: Heart Rhythm Management Center, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
authors.affiliation: Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Deep K
authors.initials: DK
authors.lastname: Pujara
authors.affiliation: Heart Rhythm Management Center, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Bowers
authors.affiliation: Heart Rhythm Management Center, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Santa Catarina, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: d'Avila
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
authors.forename: Padraig Gearoid
authors.initials: PG
authors.lastname: O'Neill
authors.affiliation: Heart Rhythm Management Center, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D002985:Clinical Protocols; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Cryoballoon; Pulmonary vein isolation; Reconnection