Characterization of pulmonary vein reconnection post Cryoballoon ablation

Abstract

Background The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mapping catheter in detecting these reconnections after cryoablation. Methods This study included 15 patients undergoing redo AF ablation after a prior single cryoablation procedure . PV reconnection sites were determined by measuring PV signals and high output pacing from 4 vectors of the Achieve catheter. The results were compared with a roving mapping catheter guided by rotational intracardiac echocardiography (ICE) in the left atrium. Results All patients had PV reconnections (2.1 ± 0.8 veins/patient). The left superior PV was most commonly reconnected (n = 11), whereas the right inferior PV was least likely (n = 3). Both carinas (left: n = 11; right: n = 7) and left atrial appendage ridge (n = 11) were also frequently reconnected. Mapping with the Achieve catheter showed a positive predictive value (PPV) 100% and negative predictive value (NPV) 96% when compared with ICE guided mapping. In 2 patients, right superior PV reconnection was not identified by the Achieve. Conclusion During redo AF ablation after index cryoablation, multiple PVs are usually reconnected, with both carinas and left atrial appendage ridge being common sites of reconnection. The Achieve mapping catheter was able to identify reconnection with high positive and negative predictive values.

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

“…In our study PV reconnections after CB PVI were most frequently observed in LSPVs. This finding is consistent with data presented by Shah et al and Glowniak et al [12,16], while Aryana et al found CTs most frequently reconnected after CB PVI [3]. The anatomical ridge between LSPV and LAA, a common reconnection site with increased wall thickness, reduces the creation of a complete transmural lesion and thus may result in frequent reconnections of the left superior PV.…”

“…To distinguish atrial far-field signals from PV potentials, coronary sinus pacing from different sites was performed, if necessary. PVI with verified entrance and exit block or absence of any electrical signal for ≥30 min was performed by the achieve catheter [12].…”

Correlation of pulmonary vein reconnection patterns after cryoballoon and duty‐cycled ablation of atrial fibrillation with the time of arrhythmia recurrence

“…These results after PVAC PVI indicate that significant PV reconnections must be expected at repeat ablation. In contrast to PVAC PVI, Shah et al found an average PV reconnection rate after CB PVI of 2.1 ± 0.8 PVs/patient, which is comparable with our data of 1.97 ± 0.8 reconnected PVs/patient 10 …”

“…After written informed consent, CB ablation was performed under mild conscious sedation, as described previously by our group 10 . A 15‐ or 20‐mm diameter inner lumen catheter (Achieve TM , Medtronic) was placed in each targeted PV to record PV signals before, during and after ablation.…”

“…To distinguish atrial far‐field signals from PV potentials, coronary sinus pacing from different sites was performed, if necessary. PVI with verified entrance and exit block or absence of any electrical signal for ≥30 minutes was performed by the achieve catheter 10 …”