Atrial Fibrillation
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21/Silent veins during cryoballoon ablation of atrial fibrillation as a novel and independent predictor of long-term outcome: results from the Middelheim-PVI Registry 2

Published Online: October 9th 2012 European Journal of Arrhythmia & Electrophysiology. 2022;8(Suppl. 1):abstr21
Authors: Y De Greef (Presenting Author) – ZNA Heart Center, Middelheim, Antwerp; I Buysschaert – Cardiovascular Center, AZ St Jan Bruges, Bruges; F Cecchini – ZNA Heart Center, Middelheim Antwerp; D Sofianos – ZNA Heart Center, Middelheim, Antwerp; M Wolf – ZNA Heart Center, Middelheim, Antwerp; B Schwagten – ZNA Heart Center, Middelheim, Antwerp; JP Abugattas – Erasmus Hospitals, Brussel, Brussels
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Background: The absence of pulmonary vein potential (PVP) recordings by the Achieve catheter occurs in 15% to 40% of the veins during cryoballoon ablation (CBA) of atrial fibrillation (AF). The long-term clinical implications of this absence of PVP during CBA are yet unknown.

Aim: To determine whether the absence of PVP recording (silent vein) by the Achieve catheter is predictive of long-term clinical outcome.

Methods and results: Out of 1,000 consecutive AF patients (mean age of 64 ± 10 years, 68% males) undergoing cryoballoon PVI (2017–2019) followed for 3 years, 803 had sufficient biophysical data for analysis. Primary outcome was clinical success, defined as freedom of documented AF without anti-arrhythmic drugs. At 3 years, clinical success was achieved in 65.3% of patients. Presence of PVP in all veins (no silent veins) was seen in 252 patients (31.4%), presence of 1 silent vein in 255 (31.8%), 2 silent veins in 159 (19.8%) and 3–4 in 137 (17.1%). Independent predictors of clinical success were persistent AF type (HR 2.05, 95%CI 1.57–2.68; p<0.001), left atrial diameter (HR 1.05, 95%CI 1.03–1.07; p<0.001) and presence of silent veins (HR 1.29, 95%CI 1.16–1.45; p<0.001) in multivariable-adjusted analysis. The highest clinical success was achieved in patients with PVPs in all veins (77.4%), gradually decreasing with increasing number of silent veins: 66.3% for 1 silent vein, 58.5% for 2 and 48.9% for 3–4 silent veins (p<0.001).

Conclusion: Presence of a silent vein during CBA of AF, defined as the absence of PVP recordings by the Achieve catheter, is an independent predictor of AF recurrence, with increasing AF recurrence per increase in silent veins. 

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