Predictors of durable pulmonary vein isolation after second-generation cryoballoon ablation with a single short freeze strategy — Different criteria for the best freeze of the 4 individual PVs

Abstract

BackgroundParameters predicting the second-generation cryoballoon pulmonary vein isolation (CB-PVI) durability of each individual PV have not been investigated. ObjectiveWe explored the PVI durability predictors after left superior (LS), left inferior (LI), right superior (RS), and right inferior (RI) PV CB-PVI. MethodsData from 101 consecutive patients who underwent repeat procedures 7.0 [4.5–10.0] months after index cryoballoon procedures with single short freeze strategies were analyzed. ResultsAmong 369 PVs successfully isolated by cryoballoons with mean freezing times of 207 s, 82/94 (87.2%) LSPVs, 78/93 (83.9%) LIPVs, 80/98 (81.6%) RSPVs, and 63/84 (75.0%) RIPVs were durable. In the remaining 25 PVs requiring touch-up ablation, 20 (83.3%) PVs had reconnections. In analyzing all PVs together, lower nadir balloon temperature, faster freezing speed (FS), slower thawing speed (TS), and shorter time-to-isolation were significantly associated with higher PVI durability, however, all parameters significantly differed among the 4 individual PVs (p < 0.0001). In individual analyses, for the LSPV, faster FS to −40 °C predicted higher PVI durability, but younger patients more likely had reconnections. For the LIPV, faster FS to −30 °C predicted higher PVI durability. For the RSPV, a lower nadir temperature, faster FS (to −30 and −40 °C), slower TS (to 0 and 15 °C), shorter time-to-isolation, and smaller PV diameter predicted higher PVI durability. For the RIPV, a slower TS (to 0 and 15 °C) predicted higher PVI durability. ConclusionsThe durability of the CB-PVI was high even with a single short freeze strategy. The parameters predicting the PVI durability differed among the 4 PVs, suggesting that best freeze criterion should be considered separately for each of the 4 PVs.