title: Characterization of Electrical Reconnection Following Pulmonary Vein Isolation Using First- and Second-Generation Cryoballoon.
abstract: Second-generation cryoballoon (CB-2) is associated with improved outcomes for pulmonary vein isolation (PVI) compared to first generation (CB-1). However, data regarding the predictors of pulmonary vein (PV) electrical reconnection are limited. In this study, we aimed to characterize the predilection sites and predictors of reconnection in patients with recurrent atrial tachyarrhythmia (ATa) after PVI using CB-1 and CB-2.
  
  
  
  A total of 59 patients (mean age: 62 ± 11 years and 66% male) with recurrent ATa after previous CB-PVI, using either a 28-mm CB-1 or CB-2, underwent repeat ablation. PV reisolation was performed by irrigated radiofrequency ablation using three-dimensional electroanatomical mapping systems.
  
  
  
  Electrical PV reconnection was detected in 10 of 11 (91%) of CB-1 patients compared to 41 of 48 (85%) of CB-2 patients. Time to redo procedure after index CB-1 was 8.9 ± 10.2 months and 11.2 ± 7.0 months in CB-2. Bonus freeze was applied in all patients with CB-1 and 41% of the patients with CB-2. Superior quadrants of both superior PVs and inferior quadrants of the both inferior PVs exhibited higher predilection for conduction compared to other quadrants (P < 0.001). Multivariate binary logistic analysis revealed that right inferior PV (RIPV; odds ratio [OR]: 1.52, 95% confidence interval [CI]: 1.09-2.13, P = 0.014) and minimum temperature (OR: 1.09, 95% CI: 1.03-1.15, P = 0.004) were the independent predictors of electrical reconnection after CB-2 ablation.
  
  
  
  Conduction gaps after CB-1 and CB-2 were higher in inferior PVs compared to superior PVs. The RIPV and minimum CB temperature were independent predictors of PV electrical reconnection after CB-2.
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Buelent
authors.initials: B
authors.lastname: Koektuerk
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Hikmet
authors.initials: H
authors.lastname: Yorgun
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Oezlem
authors.initials: O
authors.lastname: Koektuerk
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.|Department of Internal Medicine, Division of Cardiology, University Hospital of Rostock, Rostock, Germany.
authors.forename: Cem H
authors.initials: CH
authors.lastname: Turan
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Kerim
authors.initials: K
authors.lastname: Keskin
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schoett
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Ramazan G
authors.initials: RG
authors.lastname: Turan
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Eduard
authors.initials: E
authors.lastname: Gorr
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hoppe
authors.affiliation: Department of Cardiology/Electrophysiology, Krankenhaus Porz am Rhein, Witten/Herdecke University, Cologne, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Horlitz
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D003452:Cryosurgery / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000502:physiology* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies
keywords: atrial fibrillation; cryoballoon ablation; pulmonary vein isolation; pulmonary vein reconnection