Concurrent assessment of time-to-isolation and temperature at 30 s as an innovative metric for predicting the persistence of pulmonary vein isolation using second-generation cryoballoons.

Background: We attempted to establish correlations between intraoperative variables such as time-to-isolation (TTI) and temperature (T) at the 30-second mark, and the sustained efficacy of pulmonary vein isolation.

Methods: One hundred patients underwent repeat procedures subsequent to their index ablation. Five time intervals were delineated based on TTI metrics of 30, 35, 40, 45, and 60 s during the initial procedure. Subsequently, temperatures of -25 °C, -29 °C, -30 °C, and - 31 °C were determined at 30 nodes during repeat procedures, guided by the findings from the initial intervention. The prevalence of re-established pulmonary vein (PV) potentials was assessed both prior to and post each TTI and temperature assessment at the 30-second node.

Results: The incidence of reconnected PV potentials demonstrated a noteworthy reduction in the group with TTI < 30 s group than in the TTI ≥ 30. Similarly, there was a notable decrease in the incidence of reconnected PV potentials in the group with T at 30 s of < -31 ℃ than ≥ -31 ℃. The sensitivity, specificity, and positive predictive values (PPVs) for predicting durable pulmonary vein isolation were 13.19%, 94.44%, and 83.72%, respectively, in cases where the TTI was < 30 s and T at 30 s was < -31 ℃.

Conclusion: Integrating both TTI30s and T30s could potentially serve as an effective method for predicting the persistence of pulmonary vein isolation using second-generation cryoballoons.