Abstract
Background and Aim: Catheter-based atrial fibrillation (AF) ablation primarily for pulmonary vein isolation (PVI) has become a significant therapeutic alternative for symptomatic and drug-refractory AF patients. It is evident that AF time and left atrium diameter (LAD) have the most critical impact on AF recurrence. In this study, we aimed to evaluate the role of coronary artery dominance for predicting AF recurrence after cryoballoon PVI. Methods: We retrospectively analyzed clinical, laboratory, and angiographic data from consecutive patients who underwent coronary angiography and successful cryoballoon PVI. Images of the coronary angiography were retrospectively reviewed for the coronary artery dominance by two experienced observers. The coronary artery system was classified as right dominant (RD) and left dominant. Results: A total of 140 patients without coronary artery disease and structural heart disease who underwent successful cryoballoon PVI were included in the study. There were 101 RD (72%) and 39 left-dominant (28%) patterns. A total of 26 patients (22%) had developed AF recurrence during follow-up. AF recurrence rates were 41% in the left coronary-dominant group and 15% in the right coronary-dominant group (P = 0.001). According to AF recurrence after cryoballoon PVI, only follow-up time (15.7 ± 2.4 vs. 14 ± 1.8 months, P = 0.001), LAD (41.8 ± 2 vs. 40.6 ± 1.8 mm, P = 0.003) and coronary artery disease (CAD) (left CAD, 51.6% vs. 21.1%, P = 0.001) were significantly associated with AF recurrence. AF recurrence rates in multivariable logistic regression analysis according to AF recurrence after cryoballoon PVI, follow-up time, LAD, and CAD were independent predictors of AF recurrence. Conclusions: Our findings suggested that left CAD may be related to AF recurrence after cryoballoon PVI. Coronary artery dominance may be an additional predictor of AF recurrence if supported by larger prospective studies.
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