Klevringa, K.R. (Koen) (2017) Time to Effect and Other Predictors for Pulmonary Vein Reconnection After Second-Generation Cryoballoon Ablation. thesis, Medicine.
Full text available on request.Abstract
Background The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and has favorable clinical outcome. Successful isolation is associated with a shorter time to effect (TTE). However, predictors for reconnection of a pulmonary vein after a first cryoballoon PVI are not well established. Therefore, we studied the predictive value of time to effect of pulmonary vein isolation on reconnection in patients with symptomatic AF recurrences. Methods In this prospective cohort study, we included paroxysmal or persistent AF patients who were treated with 2 freeze cycles using the second-generation cryoballoon and using an intra-luminal mapping catheter between February 2012 and May 2016 in the Isala Heart Center, Zwolle, the Netherlands. Patients had a follow-up duration of 12 months and those having recurrences underwent redo procedures using radiofrequency, identifying reconnection per pulmonary vein. Patients without AF recurrences were considered as no clinical significant reconnections. Time to effect last measured excludes previous freeze cycles with insufficient contact. Results A total of 84 patients (57 male (67.9%), mean age 59.7 ± 9.4) underwent cryoballoon ablation, with 100% one-year follow-up. 28 patients (33.3%) showed recurrences of AF, 4 patients with recurrences did not have redo procedures and were therefore dismissed in further analysis. In total from 318 initially ablated pulmonary veins, reconnection was identified in 37 pulmonary veins (12%). A lower TTE measured in the last successful freeze was associated with less reconnection, 56.4 ± 32.7 vs. 69.7 ± 35.4 (p=0.037).Using a receiver operator characteristics analysis a time to effect last measured of < 49 seconds was identified as an optimal cut-off value in which reconnection was unlikely (73% sensitivity, 52% specificity, a negative predictive value of 94% and a positive predictive value of 16%). In multivariate analysis a TTE < 49 seconds (odds ratio 2.986 (1.204-7.402) p=0.018) was identified as the only independent predictor of symptomatic pulmonary vein reconnection. A learning curve was seen in the ability to measure time to effect: in the first tertile TTE was measured in 69% of the veins, 74% of the veins in the second tertile and in the last tertile in 84% of the veins TTE was measured (p=0.035). Conclusions Time to effect using an intraluminal mapping catheter during cryoballoon ablation for AF can be measured, after a learning curve, in up to 84% of pulmonary veins. Time to effect < 49 seconds is an independent predictor of clinical significant pulmonary vein reconnection and has a 94% negative predictive value of reconnection of the pulmonary vein in patients with symptomatic recurrences of atrial fibrillation.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor and Smit, J.J.J. M.D. and Isala Heart Centre and Statistical Supervisor and Brohet, R.M. Ph.D. and Statistician and Isala Academy |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:02 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2198 |
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