What features of pulmonary vein isolation procedure using 2nd generation cryoballoon are predictive of atrial arrhythmia recurrences?

Abstract

Pulmonary vein isolation procedure using 2nd generation cryoballoon (PVIPc) is routine practice but the unsuccessful rate remains at least equal to 20% without clear explanations. The objective of this study was to identify predictive factors of PVIPc failure including features of the procedure ablation. From February 2012 to April 2017, all patients who underwent a first PVIPc in Rouen University Hospital were included. Data were prospectively collected. The primary endpoint was recurrences of atrial arrythmia (atrial fibrillation, flutter, or atrial tachycardia) during follow-up. A blanking period of 3 months following PVIPc was considered. The secondary endpoints were: features of PVIPc (for each pulmonary vein: disconnection time, number of balloon applications, minus frozen temperature at disconnection, and degree of PV occlusion were assessed), pulmonary vein anatomy, recurrences of AF before hospital discharge, use of antiarrhythmic drugs during follow-up and adverse events. A Cox multivariate regression analysis was realised to search predictive factors of atrial arrhythmia recurrences. Among the 320 patients who underwent PVIPc, 233 were analysed (87 patients were excluded for lack of data beyond 4 months). During a mean follow-up of 25 ± 14 months, recurrences of atrial arrhythmia occurred in 86 patients (36.9%). In Cox multivariate regression analysis, the only predictive factor of atrial arrhythmia recurrences was left atrial enlargement (OR = 2.7; CI 95%: 1.5–4.7; P = 0.001). No features of PVIPc were reported as independent predictive factors of atrial arrhythmia recurrences, notably fast disconnection of pulmonary vein. Adverse event occurred in 50 patients (17,2%): 25 patients (10.7%) with pericardial effusion, 12 patients (5.2%) with phrenic nerve paralysis, 4 patients (1.7%) with tamponade. In our study, features of PVIPc were not predictive of atrial arrhythmia recurrences during follow-up.