Analysis Of Risk Factors Of Late Recurrence For Atrial Fibrillation Cryoballoon Ablation Procedure

Objective: To analyze the predictive value of clinical indicators,surgical parameters and anatomical parameters of pulmonary vein(PV)for atrial fibrillation(AF)recurrence after cryoballoon ablation(CBA).Methods: Patients with paroxysmal(Pa AF)or persistent(Pers AF)AF treated with28 mm second-generation cryoballoon in the Department of Cardiology of the First Hospital of China Medical University from August 2018 to October 2021 were included.The clinical history and laboratory test and examination data of the patients were collected before operation,and the surgical parameters of the patients were collected during the operation,including: the balloon temperature of each PV during freezing for30 s,60s,120 s as well as the minimum temperature,and the cumulative number and time of freezing(the first freezing time was 180s).Patients were followed up for recurrence by 12-lead ECG or 24-hour Holter ECG at 1,3,6 and 12 months after operation.According to the type of atrial fibrillation and whether there was recurrence after the operation,the difference between the two groups of patients was compared,and the independent risk factors for recurrence after cryoablation for atrial fibrillation were predicted by Logistic regression.In subgroup analysis,Logistic regression analysis was used to explore the predictive factors of PV anatomic parameters for recurrence in patients with PV CTV.The effectiveness endpoint of this study is whether atrial arrhythmia events are recorded after CBA over 3 months.Results: A total of 334 patients(mean age 62.1 years,male 55.3%,paroxysmal AF 291(87.1%))were enrolled in this study.There were significant differences in hs-TNT,BNP,LAD and LVEF between paroxysmal AF and persistent AF.The left superior pulmonary vein(LSPV),left inferior pulmonary vein(LIPV),right superior pulmonary vein(RSPV)and right inferior pulmonary vein(RIPV)had statistically significant differences in freezing temperature,times and time at each time point(P < 0.001).The superior pulmonary vein(SPV)had more freezing times than the corresponding inferior pulmonary vein(IPV),and the freezing temperature at each time point was lower,in which the balloon temperature of LIPV was the highest at each time point,while the LSPV had the most freezing times.After a median follow-up of 23(12-47)months,235patients(70.1%)were free from AF recurrence.The success rate of paroxysmal AF was72.2%,and that of persistent AF was 58.1%(p=0.06).There were statistically significant differences in baseline course of disease,hs TNT,e GFR,PV balloon temperature,LIPV freezing time and number of freezing between the non-recurrence group and the recurrence group.Among them,there were statistically significant differences in each PV30 s balloon temperature between the recurrence group and the non-recurrence group.The receiver operating characteristic curve(ROC)was drawn for each PV30 s balloon temperature to evaluate its predictive value for recurrence after CBA.The area under the curve(AUC)of LIPV30 s balloon temperature was largest(AUC=0.623,p<0.01)with the cut-off value-27.5℃(sensitivity=59.6% and specificity=61.2%).Logistic regression analysis showed that higher LIPV30 s balloon temperature(OR=1.070,95%CI=1.002-1.14;p=0.044)and early recurrence(OR=18.018,95%CI=7.834-41.443 p<0.001)were independently associated with recurrence.The risk of recurrence in patients with LIPV30 >-27.5℃ was 1.701 times higher than the other(95%CI=1.002-1.143;p=0.008).Subgroup analysis of patients with PV CTV showed that the anatomical parameters of each PV were different.Specifically,the diameter,circumference and area of SPV were larger than those of IPV,and the eccentricity index(EI)of LPV was larger than that of RPV.LIPV had the smallest diameter,circumference,and area and the largest EI(the flatest).The results showed that the 30 s,60s and minimum temperature were negatively correlated with the diameter,but positively correlated with the EI,and all the anatomical parameters were most correlated with the minimum temperature.In the separate analysis for each PV,only the temperature of LIPV was positively correlated with EI(r=.311,P<0.001),while the intraoperative parameters of RIPV had the weakest correlation with anatomic parameters.Univariate analysis suggested that there was a difference in the LSPV length between the recurrence group and the non-recurrence group.Stepwise Logistic regression analysis in subgroups showed that longer LSPV length(OR=1.087,95%CI=1.006-1.175 p=0.035)and early recurrence were independently associated with postoperative recurrence.ROC showed that LSPV long diameter had limited predictive value for AF recurrence(AUC=0.578,p=0.068).Conclusion: After a median follow-up of 23 months,the AF-free rate was 70.4%.Higher LIPV30 s balloon temperature and early recurrence are independently associated with recurrence after CBA.Subgroup analysis suggested that larger LSPV length was also independently associated with AF recurrence,but its predictive value for AF recurrence was limited because of bonus freezing.