The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon

Deubner, Nikolas; Greiß, Harald; Akkaya, Ersan; Zaltsberg, Sergej; Hain, Andreas; Berkowitsch, Alexander; Güttler, Norbert; Kuniss, Malte; Neumann, Thomas

doi:10.1093/europace/euw192

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…Many previous reports have stated that it is difficult to obtain a complete occlusion of the RIPV [2,6,12,13] . In a PVI based on the CB, we usually position the CB so that the CB can evenly adhere to the PV orifice.…”

Section: Discussionmentioning

confidence: 99%

“Clinical Impact of the Cryoballoon Temperature and Occlusion Status on the Success of Pulmonary Vein Isolation”

Nishimura

Okishige

Yamauchi

et al. 2018

Journal of Atrial Fibrillation

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Background: Complete occlusion of the pulmonary veins (PVs) with the cryoballoon (CB) is considered to be the crucial factor for a successful PV isolation (PVI). We investigated whether a complete occlusion was indispensable for a successful CB based PVI of every PV. Methods and Results: TAtrial fibrillation patients (n=123, 97; paroxysmal) undergoing a de novo PVI were enrolled. A total of 477 PVs were analyzed. The occlusion grade (OG) was scored as follows: OG3 (complete occlusion), OG2 (incomplete occlusion with slight leakage), OG1 (poor occlusion with massive leakage). There was no significant difference in the CB temperature (CBT) at all measured time points (from 30 to 120sec after freezing) and nadir CBT between OG2 and OG3 in all PVs except for the right inferior PV (RIPV). The RIPV isolation success rate was significantly lower for the OG2 status than OG3 (97.5 vs. 57.6%; p<0.0001). In contrast, there was not significant difference in the isolation success rate of the other three PVs between OG2 and OG3. In particular, the success rate of the right superior PV (RSPV) isolation was >95% for both OG2 and OG3. Phrenic nerve paralysis (PNP) was provoked during the RSPV isolation in two patients in whom the RSPVs were frozen during OG3. Conclusions: An OG3 may not always be required for a successful PVI of all PVs except the RIPV. OG2 could have comparable effects as OG3 in terms of a successful RSPV isolation. Not aiming for OG3 for the RSPV may reduce the risk of PNP.

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Section: Discussionmentioning

confidence: 99%

“Clinical Impact of the Cryoballoon Temperature and Occlusion Status on the Success of Pulmonary Vein Isolation”

Nishimura

Okishige

Yamauchi

et al. 2018

Journal of Atrial Fibrillation

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“…In this study, we found that thawing rate was a novel predictor of acute PVI, which could provide a certain reference value when factors such as cryoablation temperature and time cannot effectively predict PVI. Deubner et al found that a 20-second time frame with a freezing rate of <17°C could best predict PVI ( 21 ). Meanwhile, our study showed that the ITR15 was the most valuable predictor of acute PVI.…”

Section: Discussionmentioning

confidence: 99%

“…Cryoablation curves from 592 cryoablations were reconstructed using these data ( Figure 1A ). Our aim was to quantify the thawing rate by fitting a regression line to a specific portion of the cryoablation curve ( 21 ). The slope of the regression line ( Figure 1B ) provided an immediate measure of the rapidity of the temperature rise.…”

Section: Methodsmentioning

confidence: 99%

Thawing Rate Predicts Acute Pulmonary Vein Isolation after Second-Generation Cryoballoon Ablation

Zhang

You

et al. 2020

Clinics

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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.

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“…Recent articles have highlighted the importance of temperature attainment as a predictor of successful PV isolation. Deubner et al [13] interestingly demonstrated that a steeper temperature slope descent in the first instances of the freeze proved to reliably predict acute PV isolation. In addition, Iacopino et al [11] showed comparable clinical outcomes between a traditional approach with an ILMC and an ablation strategy solely guided by temperature in the setting of second generation CB ablation.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Recordings in Cryoballoon Pulmonary Veins Isolation: Comparison Between the 25mm and the 20mm Achieve Catheters

Salghetti

Abugattas

Regibus

et al. 2018

Journal of Atrial Fibrillation

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The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon

Cited by 12 publications

References 21 publications

“Clinical Impact of the Cryoballoon Temperature and Occlusion Status on the Success of Pulmonary Vein Isolation”

“Clinical Impact of the Cryoballoon Temperature and Occlusion Status on the Success of Pulmonary Vein Isolation”

Thawing Rate Predicts Acute Pulmonary Vein Isolation after Second-Generation Cryoballoon Ablation

Real-Time Recordings in Cryoballoon Pulmonary Veins Isolation: Comparison Between the 25mm and the 20mm Achieve Catheters

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