Abstract
Aims: To compare the procedural outcomes of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in atrial fibrillation (AF) patients with the common ostium of inferior pulmonary veins (COIPV) and to explore the effect of COIPV on CBA performance through the assessment of anatomical factors.Methods: A total of 18 AF patients with COIPV were included. Pulmonary vein isolation (PVI) was performed with second-generation CBA or RFA. The anatomical characteristics of COIPV and procedural outcomes were collected.Results: The prevalence of COIPV was 0.82% in the enrolled population. PVI was achieved in all pulmonary veins (PVs) without any complications. The “tricircle” strategy was applied for RFA, and the segmental freeze strategy was performed for CBA. Compared with RFA, CBA had shorter procedural time (median: 53.0 vs. 78.0 min, p < 0.001) and longer fluoroscopy time (median: 13.5 vs. 6.0 min, p < 0.001). Higher ovality index of the ostium was seen in patients with ≥4 freezes in inferior PVs [IPVs; 0.95 (0.78–1.05) vs. 0.49 (0.21–0.83), p = 0.047]. During a median of 23.5 months of follow-up, the atrial arrhythmias-free survival after the procedure was comparable between CBA and RFA (p = 0.729).Conclusion: The second-generation CBA is an efficient and safe alternative for RFA in AF patients with COIPV. Anatomical characteristics of COIPV bring the challenge to the procedure performance of RFA and CBA.
Highlights
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia, which affects ∼1–2% of the entire population [1]
This study compares the procedural outcomes of Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in AF patients with common ostium of inferior pulmonary veins (COIPV) and to explore the effect of COIPV on CBA performance through the anatomical data of COIPV
There was no significant difference in baseline characteristics between RFA and CBA groups (Table 1)
Summary
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia, which affects ∼1–2% of the entire population [1]. Pulmonary vein isolation (PVI) has been recognized as the cornerstone of catheter ablation for AF treatment [2, 3]. The common ostium of inferior pulmonary veins (COIPV) is an unusual variation of pulmonary venous drainage, whose anatomical characteristics and electrophysiology are rarely demonstrated. For AF ablation in patients with COIPV, the feasibility and safety of cryoballoon ablation (CBA) have been firstly reported by Xie et al [4]. Studies comparing radiofrequency ablation (RFA) and CBA have been scarcely reported, and no data on the relationship between anatomical factors of COIPV and procedural difficulty of CBA are available.
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