Are procedural parameters predictive of atrial fibrillation recurrence after pulmonary vein isolation using second generation cryoballoon?

Abstract

Pulmonary vein isolation (PVI) is now widely performed using cryoballoon technology. Despite technological improvements (second generation of cryoballoon), atrial fibrillation (AF) recurrences are observed in roughly 20% of the patients. The aim of the study was to look for predictive factors of AF recurrences during follow-up regarding parameters of PVI using 2nd generation cryoballoon therapy. It was an observational, retrospective and monocentric study. Between June 2012 and April 2017, all patients undergone PVI using 2nd generation cryoballoon therapy at Rouen University Hospital were included. The primary endpoint was AF recurrences during follow-up. The secondary endpoints were the parameters of the procedure (for each vein: disconnection time, balloon application number, minimal balloon temperature, and level of vein occlusion), the occurrence of a redo-procedure and adverse events. In total, 320 patients were included. Among them, 233 patients were analysed (87 patients were excluded for lack of data). AF recurrence rate was 36.9% ( N = 86) for a mean follow-up of 25 ± 14 months. The mean delay of recurrences was 10 ± 12 months. No procedure parameters of PVI using 2nd generation cryoballoon therapy were predictive of AF recurrences. Only left atrial enlargement was predictive of AF recurrences (OR = 2.70; CI95% [1.54–4.72], P = 0.001). The redo procedure rate was 17.9% ( N = 42). Among these 42 patients, 32 (75.6%) had at least one pulmonary vein reconnected, mainly the right inferior pulmonary vein. No parameters were predictive of pulmonary vein reconnection. In patients undergone PVI using 2nd generation cryoballoon, no procedure parameters seem to be predictive of AF recurrences during follow-up.