Evaluation of efficacy and identification of predictors of recurrence in patients after pulmonary vein cryoballoon ablation

Abstract

Aim. To evaluate the effectiveness and identify predictors of recurrence after pulmonary veins (PV) cryoballoon isolation patients with atrial fibrillation (AF). Methods. In total, the study included 100 patients who met the selection criteria. Depending on the form and duration of AF paroxysms documented by ECG and Holter monitoring, patients were divided into two groups. The first group included 57 patients with paroxysmal AF (57%), and the second group included 43 patients with persistent AF (43%). Results. As a result of our study, important achievements of the greatest efficiency during cryoballon ablation were identified: isolation of all PV; achievement of the “input-output” block (elimination of spike activity according to the diagnostic electrode in the PV during appplication), which was recorded at a temperature of -30 and more °C; the minimum appplication time is 180 sec after reaching the entry-exit block. An electroanatomical diagram of the left atrium with a high frequency of left atrium and PV activity in patients with paroxysmal and persistent forms of AF was developed. Nine zones with pronounced activity were identified, more pronounced zones with low-amplitude activity in patients with persistent AF. The multivariate Cox analysis showed predictors, an exceptional effect on the risk of AF recurrence after cryoballoon ablation: the presence of diabetes mellitus led to the risk of AF recurrence by 2.39, incomplete isolation of the PV by 3.98 times, the value of left atrial volume index ≥ 61.9 ml/m 2 in 2.91 times, peak atrial longitudinal strain value of left atrium ≤29.3. Conclusion. The results of the study allow us to determine the criteria for high efficiency during cryoballoon ablation, as well as a high-risk group for relapse. When selecting patients for cryoballoon control of PV coronavirus, with the achievement of a greater one, possible factors should be considered: indexed volume of left atrium according to multispiral computed tomography, peak atrial longitudinal strain value of left atrium, absence of diabetes mellitus.