Disappearance pattern and the last remaining earliest pulmonary vein potential during cryoballoon ablation in predicting recurrence and conduction gap site of pulmonary veins
- 26 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Heart and Vessels
- Vol. 36 (8), 1-11
- https://doi.org/10.1007/s00380-021-01785-3
Abstract
Electrophysiological studies have rarely evaluated the sites prone to pulmonary vein (PV) conduction gap during cryoballoon ablation (CBA) for atrial fibrillation (AF). In addition, no studies have analyzed the sequence of PV potentials just before PV isolation during CBA for AF. Of the 238 patients who underwent first-time CBA for paroxysmal AF, 115 PVs of 29 patients who underwent repeat session due to recurrence after the procedure were retrospectively evaluated in the study. We evaluated the disappearance pattern of PV potential and PV reconnection on intracardiac electrograms and investigated whether the conduction gap site of the PV was related to the last remaining earliest PV potential (EP) and sequence pattern during the first-time CBA. Time to isolation was observed in 81 PVs during the first-time CBA. At the repeat session, PV reconnection was only observed in 22 of 81 PVs. PV potentials disappeared with sequence changes in 36 PVs and without sequence changes in 38 PVs. Multivariate analysis demonstrated that disappearance of PV potentials without change in the EP site but with delay or disappearance of other PV potentials was independently associated with PV reconnection (12/22 PVs [55%] vs. 4/59 PVs [6.8%]; odds ratio 14.4; 95% confidence interval 3.75–55.5; p < 0.001). In 19 of 22 (86%) reconnected PVs, PV conduction gap sites at repeat ablation corresponded with the last remaining EP sites during first-time CBA. In conclusion, disappearance pattern of the PV potential and the last remaining EP during the CBA can predict PV reconnection and gap site.Keywords
This publication has 16 references indexed in Scilit:
- Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Short- and long-term results of a multicenter studyHeart Rhythm, 2016
- Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trialEuropean Heart Journal, 2016
- Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial FibrillationThe New England Journal of Medicine, 2016
- Characterization of Electrical Reconnection Following Pulmonary Vein Isolation Using First- and Second-Generation CryoballoonPacing and Clinical Electrophysiology, 2016
- Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoonEP Europace, 2016
- Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) StudyJournal of Cardiovascular Electrophysiology, 2015
- Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolationHeart Rhythm, 2015
- Validation of a novel spiral mapping catheter for real-time recordings from the pulmonary veins during cryoballoon ablation of atrial fibrillationHeart Rhythm, 2012
- Single Transseptal Big Cryoballoon Pulmonary Vein Isolation using an Inner Lumen Mapping CatheterPacing and Clinical Electrophysiology, 2012
- Pressure‐Guided Cryoballoon Isolation of the Pulmonary Veins for the Treatment of Paroxysmal Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2010