Abstract
OBJECTIVE:To evaluate whether thawing rate could be a novel predictor of acute pulmonary vein isolation (PVI) and explore the predictive value of thawing rate as a factor ensuring long-term PVI (vagus reflex).METHODS:A total of 151 patients who underwent cryoballoon ablation for atrial fibrillation (AF) were enrolled in this retrospective study between January 2017 and June 2018. The thawing rate was calculated using the thawing phase of the cryoablation curve. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the thawing rate for acute PVI and vagus reflex.RESULTS:ROC curve analyses revealed that the interval thawing rate at 15°C (ITR15) was the most valuable predictor of PVI, with the highest area under curve (AUC) value of the ROC curve. The best cut-off value of ITR15 for PVI was ≤2.14°C/S and its sensitivity and specificity were 88.62% and 67.18%, respectively. In addition, the ITR15 of the successful PVI group after cryoballoon ablation was significantly slower than the failed PVI group. ITR15 was a predictor of vagus reflex and the occurrence of vagus reflex group had a slower ITR15 compared to the non-occurrence group.CONCLUSIONS:Thawing rate was a novel predictor of acute PVI and the ITR15 was the most valuable predictor of acute PVI. In addition, ITR15 was a predictive factor ensuring long-term PVI (vagus reflex). Our study showed that thawing rate may serve in the early identification of useless cryoballoon ablation.
Highlights
Pulmonary vein isolation (PVI) is the main treatment for atrial fibrillation (AF) [1]
We aimed to evaluate whether thawing rate could be a novel predictor of acute PVI and explore the predictive value of the thawing rate for vagus reflex
Thawing rate predicts acute PVI We first evaluated whether thawing rate could be a novel predictor for acute PVI
Summary
Pulmonary vein isolation (PVI) is the main treatment for atrial fibrillation (AF) [1]. Cryoballoon ablation as an efficient and relatively safe procedure that is increasingly being used to perform PVI in patients with AF in recent years [2,3]. Cryoballoon ablation is not inferior to radiofrequency ablation with respect to efficacy for the treatment of AF and there is a lower re-hospitalization rate and re-ablation rate in cryoablation ablation [4,5]. Previous studies have shown that the second-generation cryoballoon is an effective and safe technique in achieving both favorable clinical outcomes and acute PVI [6,7,8,9]. Recently published data indicates that approximately 90% of PVs are still isolated 3 months after second-generation cryoballoon ablation [10].
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