TY - JOUR
T1 - Spontaneous and adenosine-induced pulmonary vein reconnection after cryoballoon ablation with the second-generation device
AU - Ciconte, Giuseppe
AU - Chierchia, Gian Battista
AU - De Asmundis, Carlo
AU - Sieira, Juan
AU - Conte, Giulio
AU - Juliá, Justo
AU - Di Giovanni, Giacomo
AU - Wauters, Kristel
AU - Baltogiannis, Giannis
AU - Saitoh, Yukio
AU - Mugnai, Giacomo
AU - Catanzariti, Domenico
AU - Tondo, Claudio
AU - Brugada, Pedro
PY - 2014
Y1 - 2014
N2 - Second-generation Cryoballoon Ablation and Pulmonary Vein Reconnections Introduction Longer observational time and adenosine challenge have proven to be able to detect pulmonary vein (PV) reconnections. The aim of this study was to assess incidence of spontaneous and adenosine-induced PV reconnection after ablation with second-generation cryoballoon (CB-Adv). Methods and Results Fifty consecutive patients (76% male, mean age 60.5 ± 11.9 years) having undergone PV isolation (PVI) using the CB-Adv were enrolled. After isolation, reconnections were evaluated using the Achieve catheter over 30 minutes observation and adenosine administration during isoproterenol infusion (adenosine challenge). Among 200 PVs, isolation was achieved in 190 (95%) during the first application. Lower nadir temperature and longer rewarming time were associated with successful PVI (P = 0.02 and 0.04). Spontaneous (4 veins) and adenosine-induced (4 veins) PV reconnections occurred in the 4% of initially isolated veins (8 veins) in 6 patients (12%). At receiver-operator curve analysis, nadir temperature 28 seconds identified absence of reconnections (sensitivity 100% and 87%, area under the curve 0.75 and 0.72). Patients with right-sided early branching frequently experienced reconnections (P <0.01). After a mean follow-up of 7.0 ± 1.7 months, 86% of patients were free from atrial fibrillation. None of those with PV reconnections experienced recurrences. Conclusions The incidence of spontaneous and adenosine-induced PV reconnection following ablation with the novel CB-Adv is very low occurring in 4% of initially isolated veins. Nadir temperature 28 seconds identified absence of acute reconnections, thus avoiding prolonged waiting time and adenosine challenge in such cases.
AB - Second-generation Cryoballoon Ablation and Pulmonary Vein Reconnections Introduction Longer observational time and adenosine challenge have proven to be able to detect pulmonary vein (PV) reconnections. The aim of this study was to assess incidence of spontaneous and adenosine-induced PV reconnection after ablation with second-generation cryoballoon (CB-Adv). Methods and Results Fifty consecutive patients (76% male, mean age 60.5 ± 11.9 years) having undergone PV isolation (PVI) using the CB-Adv were enrolled. After isolation, reconnections were evaluated using the Achieve catheter over 30 minutes observation and adenosine administration during isoproterenol infusion (adenosine challenge). Among 200 PVs, isolation was achieved in 190 (95%) during the first application. Lower nadir temperature and longer rewarming time were associated with successful PVI (P = 0.02 and 0.04). Spontaneous (4 veins) and adenosine-induced (4 veins) PV reconnections occurred in the 4% of initially isolated veins (8 veins) in 6 patients (12%). At receiver-operator curve analysis, nadir temperature 28 seconds identified absence of reconnections (sensitivity 100% and 87%, area under the curve 0.75 and 0.72). Patients with right-sided early branching frequently experienced reconnections (P <0.01). After a mean follow-up of 7.0 ± 1.7 months, 86% of patients were free from atrial fibrillation. None of those with PV reconnections experienced recurrences. Conclusions The incidence of spontaneous and adenosine-induced PV reconnection following ablation with the novel CB-Adv is very low occurring in 4% of initially isolated veins. Nadir temperature 28 seconds identified absence of acute reconnections, thus avoiding prolonged waiting time and adenosine challenge in such cases.
KW - adenosine
KW - atrial fibrillation
KW - cryoballoon ablation
KW - pulmonary vein isolation
KW - pulmonary vein reconnection
KW - second-generation cryoballoon
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U2 - 10.1111/jce.12421
DO - 10.1111/jce.12421
M3 - Article
C2 - 24678900
AN - SCOPUS:84905825424
VL - 25
SP - 845
EP - 851
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
IS - 8
ER -