Fehmi Keçe

Predicting Early Reconnection with Procedural and Biophysical Parameters 145 7 7.1 Introduction Cryoballoon ablation is an effective treatment for drug-resistant atrial fibrillation (AF) due to its ease of use, its low complication rates and shorter procedural times compared to radiofrequency catheter ablation (1). AF-recurrence rates after cryoballoon ablation can be decreased if a 30-minute waiting period for detecting early pulmonary vein (PV) reconnection is applied, followed by testing with adenosine for identifying dormant conduction (2-6). However, this approach is time-consuming and infusion of adenosine is associated with patient discomfort. Therefore, predicting the absence of early PV reconnection and dormant conduction immediately after a cryoballoon application would be desirable. In a prior study, a time-to-isolation ≤60 seconds and a thawing time to 0°C of ≥10 seconds during the index cryoablation were associated with durable PV isolation assessed during a repeat ablation 14±3 months after the index procedure (7). However, sites of early (after 30-min) reconnection may differ from sites of late (repeated procedure) reconnection (6) and biophysical data associated with late reconnection may not predict early reconnection/dormant conduction (ERC). The purpose of this study was therefore to identify procedural and biophysical parameters to predict the absence of ERC at the time of the index procedure.