Predictors of a successful “crosstalk” ablation technique during
second-generation cryoballoon ablation in patients with atrial
fibrillation
Abstract
Introduction: The “crosstalk” (CST) ablation technique has been
reported to reduce unnecessary ablation during cryoballoon (CB) ablation
(CBA). Nevertheless, it is unclear which situations will necessitate the
adoption of the technique. Methods and Results: The effect of the
technique was analyzed in AF patients underwent CBA from July 2017 to
February 2020. The balloon occlusion status and nadir temperature (NT)
were compared, and all ablated PVs were categorized into three groups
according to the necessity and effectiveness of the technique. Of 1082
superior PVs (SPVs), 16, 40, and 1026 were identified in the CST success
group, CST failure group, and control group, respectively. The
proportion of SPVs ablated with complete occlusion with CB was
significantly higher in the CST success group (100%) than in the CST
failure group (16.7%) or control group (49.4%) (CST success group vs.
CST failure group, p<0.001; CST success group vs. control
group, p<0.002). The proportion of SPVs ablated with NT ≤-46°C
was higher in the CST success group (100%) than in the CST failure
group (56.7%) (p<0.05). The CST ablation technique was always
effective if CBA of the SPVs was performed with both complete occlusion
and NT ≤-46°C and was almost always ineffective if it did not meet these
two criteria (sensitivity, 100%; specificity, 93%). Conclusion:
Successful CST ablation was highly predicted if complete PV occlusion
and NT ≤-46°C during CBA of the SPVs were achieved, which could be
useful when adopting the technique targeting inferior PVs to reduce
unnecessary freezing during SPV isolation.