Validation of a prediction model for early reconnection after cryoballoon ablation

Abstract

Abstract Background We previously developed an early reconnection/dormant conduction (ERC) prediction model for cryoballoon ablation to avoid a 30-min waiting period with adenosine infusion. We now aimed to validate this model based on time to isolation, number of unsuccessful cryo-applications, and nadir balloon temperature. Methods Consecutive atrial fibrillation patients who underwent their first cryoballoon ablation in 2018–2019 at the Leiden University Medical Center were included. Model performance at the previous and at a new optimal cutoff value was determined. Results A total of 201 patients were included (85.57% paroxysmal AF, 139 male, median age 61 years (IQR 53–69)). ERC was found in 35 of 201 included patients (17.41%) and in 41 of 774 veins (5.30%). In the present study population, the previous cutoff value of − 6.7 provided a sensitivity of 37.84% (previously 70%) and a specificity of 89.07% (previously 86%). Shifting the cutoff value to − 7.2 in both study populations resulted in a sensitivity of 72.50% and 72.97% and a specificity of 78.22% and 78.63% in data from the previous and present study respectively. Negative predictive values were 96.55% and 98.11%. Applying the model on the 101 patients of the present study with all necessary data for all veins resulted in 43 out of 101 patients (43%) not requiring a 30-min waiting period with adenosine testing. Two patients (2%) with ERC would have been missed when applying the model. Conclusions The previously established ERC prediction model performs well, recommending its use for centers routinely using adenosine testing following PVI. Graphical Abstract