The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2
Background Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15–40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI. Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical...
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| Veröffentlicht in: | Journal of interventional cardiac electrophysiology 2023-12, Vol.66 (9), p.2091-2101 |
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| creator | De Greef, Y. Sofianos, D. Tijskens, M. Schwagten, B. Wolf, M. Buysschaert, I. Abugattas, J. P. |
| description | Background
Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15–40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI.
Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI.
Methods
Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (
N
= 252 [31.4%]), 1 (
N
= 255 [31.8%]), 2 (
N
= 159 [19.8%]), and 3–4 (
N
= 137 [17.1]).
Results
At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134–1.433;
p
|
| doi_str_mv | 10.1007/s10840-023-01538-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2802425565</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2802425565</sourcerecordid><originalsourceid>FETCH-LOGICAL-c298t-68fc23837472e32fc177bc08965f99a734293f4f7a0ad0312a9cb9bac3a541e73</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0EojdegAXyspsUX-I4XqKKQqVKbA5ra-KMW1eJfbCToj4Nr4pPz6GqumDlkeebfy4_IR85u-CM6c-Fs75lDROyYVzJvmnfkGOutGh6ZdTbF_EROSnlnjFmmOjekyOpWad1p47Jn80dUhgKRoc0eZoRpmYJM9LtOs0pQn6kDxgiDSVNsIQU6bjmEG-py49pgGlK9QuGQy4UCqUkF2DBkf4Oyx2FJQeYqA9DDtMBy-jWnJ96Qhxft6rZFCO6HXpG3nmYCn44vKfk59XXzeX35ubHt-vLLzeNE6Zfmq73Tshe6lYLlMI7rvXgWG865Y0BLVthpG-9BgYjk1yAcYMZwElQLUctT8n5Xneb068Vy2LnUBzWgSOmtVjRM9EKpTpVUbFHXU6lZPR2m8Ncp7ec2Z0xdm-MrcbYJ2NsW4s-HfTXYcbxueSfExWQe6Bsd-fFbO_TmmPd-X-yfwEz4J1H</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2802425565</pqid></control><display><type>article</type><title>The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2</title><source>SpringerNature Journals</source><creator>De Greef, Y. ; Sofianos, D. ; Tijskens, M. ; Schwagten, B. ; Wolf, M. ; Buysschaert, I. ; Abugattas, J. P.</creator><creatorcontrib>De Greef, Y. ; Sofianos, D. ; Tijskens, M. ; Schwagten, B. ; Wolf, M. ; Buysschaert, I. ; Abugattas, J. P.</creatorcontrib><description>Background
Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15–40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI.
Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI.
Methods
Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (
N
= 252 [31.4%]), 1 (
N
= 255 [31.8%]), 2 (
N
= 159 [19.8%]), and 3–4 (
N
= 137 [17.1]).
Results
At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134–1.433;
p
< 0.01), independent of persistent AF type (HR = 2.075; 95% CI 1.584–2.738;
p
< 0.01), left atrial diameter (HR = 1.050; 95% CI 1.028–1.072;
p
< 0.01), and diagnosis-to-ablation time (HR = 1.002; 95% CI 1.000–1.005;
p
= 0.04). Highest success was achieved with present real-time PVI in all veins (77.4%), gradually decreasing per increasing number of absent real-time PVI: 66.3% for 1 vein, 58.5% for 2, and 48.9% for 3–4 veins (
p
< 0.001). At repeat ablation (
N
= 188), PV reconnection was seen in 99/430 (23.0%) versus 83/288 (28.8%) veins with and without real-time PVI, respectively (
p
= 0.08). Right inferior PVs (RIPVs) with real-time PVI were less reconnected than RIPVs without real-time PVI: 29.7% versus 43.7% (
p
= 0.047).
Conclusion
The absence of real-time PVI during CBA independently predicts AF recurrence with a 30% gradual decrease in outcome per increase in veins without real-time PVI. Real-time PVI is particularly important for the RIPV to achieve durable PVI.</description><identifier>ISSN: 1572-8595</identifier><identifier>EISSN: 1572-8595</identifier><identifier>DOI: 10.1007/s10840-023-01538-4</identifier><identifier>PMID: 37067765</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Cardiology ; Medicine ; Medicine & Public Health</subject><ispartof>Journal of interventional cardiac electrophysiology, 2023-12, Vol.66 (9), p.2091-2101</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-68fc23837472e32fc177bc08965f99a734293f4f7a0ad0312a9cb9bac3a541e73</cites><orcidid>0000-0003-1367-4867</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10840-023-01538-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10840-023-01538-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37067765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Greef, Y.</creatorcontrib><creatorcontrib>Sofianos, D.</creatorcontrib><creatorcontrib>Tijskens, M.</creatorcontrib><creatorcontrib>Schwagten, B.</creatorcontrib><creatorcontrib>Wolf, M.</creatorcontrib><creatorcontrib>Buysschaert, I.</creatorcontrib><creatorcontrib>Abugattas, J. P.</creatorcontrib><title>The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2</title><title>Journal of interventional cardiac electrophysiology</title><addtitle>J Interv Card Electrophysiol</addtitle><addtitle>J Interv Card Electrophysiol</addtitle><description>Background
Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15–40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI.
Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI.
Methods
Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (
N
= 252 [31.4%]), 1 (
N
= 255 [31.8%]), 2 (
N
= 159 [19.8%]), and 3–4 (
N
= 137 [17.1]).
Results
At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134–1.433;
p
< 0.01), independent of persistent AF type (HR = 2.075; 95% CI 1.584–2.738;
p
< 0.01), left atrial diameter (HR = 1.050; 95% CI 1.028–1.072;
p
< 0.01), and diagnosis-to-ablation time (HR = 1.002; 95% CI 1.000–1.005;
p
= 0.04). Highest success was achieved with present real-time PVI in all veins (77.4%), gradually decreasing per increasing number of absent real-time PVI: 66.3% for 1 vein, 58.5% for 2, and 48.9% for 3–4 veins (
p
< 0.001). At repeat ablation (
N
= 188), PV reconnection was seen in 99/430 (23.0%) versus 83/288 (28.8%) veins with and without real-time PVI, respectively (
p
= 0.08). Right inferior PVs (RIPVs) with real-time PVI were less reconnected than RIPVs without real-time PVI: 29.7% versus 43.7% (
p
= 0.047).
Conclusion
The absence of real-time PVI during CBA independently predicts AF recurrence with a 30% gradual decrease in outcome per increase in veins without real-time PVI. Real-time PVI is particularly important for the RIPV to achieve durable PVI.</description><subject>Cardiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><issn>1572-8595</issn><issn>1572-8595</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1TAQhi0EojdegAXyspsUX-I4XqKKQqVKbA5ra-KMW1eJfbCToj4Nr4pPz6GqumDlkeebfy4_IR85u-CM6c-Fs75lDROyYVzJvmnfkGOutGh6ZdTbF_EROSnlnjFmmOjekyOpWad1p47Jn80dUhgKRoc0eZoRpmYJM9LtOs0pQn6kDxgiDSVNsIQU6bjmEG-py49pgGlK9QuGQy4UCqUkF2DBkf4Oyx2FJQeYqA9DDtMBy-jWnJ96Qhxft6rZFCO6HXpG3nmYCn44vKfk59XXzeX35ubHt-vLLzeNE6Zfmq73Tshe6lYLlMI7rvXgWG865Y0BLVthpG-9BgYjk1yAcYMZwElQLUctT8n5Xneb068Vy2LnUBzWgSOmtVjRM9EKpTpVUbFHXU6lZPR2m8Ncp7ec2Z0xdm-MrcbYJ2NsW4s-HfTXYcbxueSfExWQe6Bsd-fFbO_TmmPd-X-yfwEz4J1H</recordid><startdate>20231201</startdate><enddate>20231201</enddate><creator>De Greef, Y.</creator><creator>Sofianos, D.</creator><creator>Tijskens, M.</creator><creator>Schwagten, B.</creator><creator>Wolf, M.</creator><creator>Buysschaert, I.</creator><creator>Abugattas, J. P.</creator><general>Springer US</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1367-4867</orcidid></search><sort><creationdate>20231201</creationdate><title>The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection</title><author>De Greef, Y. ; Sofianos, D. ; Tijskens, M. ; Schwagten, B. ; Wolf, M. ; Buysschaert, I. ; Abugattas, J. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-68fc23837472e32fc177bc08965f99a734293f4f7a0ad0312a9cb9bac3a541e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cardiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>De Greef, Y.</creatorcontrib><creatorcontrib>Sofianos, D.</creatorcontrib><creatorcontrib>Tijskens, M.</creatorcontrib><creatorcontrib>Schwagten, B.</creatorcontrib><creatorcontrib>Wolf, M.</creatorcontrib><creatorcontrib>Buysschaert, I.</creatorcontrib><creatorcontrib>Abugattas, J. P.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of interventional cardiac electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De Greef, Y.</au><au>Sofianos, D.</au><au>Tijskens, M.</au><au>Schwagten, B.</au><au>Wolf, M.</au><au>Buysschaert, I.</au><au>Abugattas, J. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2</atitle><jtitle>Journal of interventional cardiac electrophysiology</jtitle><stitle>J Interv Card Electrophysiol</stitle><addtitle>J Interv Card Electrophysiol</addtitle><date>2023-12-01</date><risdate>2023</risdate><volume>66</volume><issue>9</issue><spage>2091</spage><epage>2101</epage><pages>2091-2101</pages><issn>1572-8595</issn><eissn>1572-8595</eissn><abstract>Background
Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15–40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI.
Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI.
Methods
Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (
N
= 252 [31.4%]), 1 (
N
= 255 [31.8%]), 2 (
N
= 159 [19.8%]), and 3–4 (
N
= 137 [17.1]).
Results
At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134–1.433;
p
< 0.01), independent of persistent AF type (HR = 2.075; 95% CI 1.584–2.738;
p
< 0.01), left atrial diameter (HR = 1.050; 95% CI 1.028–1.072;
p
< 0.01), and diagnosis-to-ablation time (HR = 1.002; 95% CI 1.000–1.005;
p
= 0.04). Highest success was achieved with present real-time PVI in all veins (77.4%), gradually decreasing per increasing number of absent real-time PVI: 66.3% for 1 vein, 58.5% for 2, and 48.9% for 3–4 veins (
p
< 0.001). At repeat ablation (
N
= 188), PV reconnection was seen in 99/430 (23.0%) versus 83/288 (28.8%) veins with and without real-time PVI, respectively (
p
= 0.08). Right inferior PVs (RIPVs) with real-time PVI were less reconnected than RIPVs without real-time PVI: 29.7% versus 43.7% (
p
= 0.047).
Conclusion
The absence of real-time PVI during CBA independently predicts AF recurrence with a 30% gradual decrease in outcome per increase in veins without real-time PVI. Real-time PVI is particularly important for the RIPV to achieve durable PVI.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37067765</pmid><doi>10.1007/s10840-023-01538-4</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-1367-4867</orcidid></addata></record> |
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| subjects | Cardiology Medicine Medicine & Public Health |
| title | The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection: Insights from the Middelheim-PVI Registry 2 |
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