Effectiveness of cryoballoon ablation for atrial fibrillation in patients with left common pulmonary vein variant: insights from a national multicenter catheter ablation registry

Abstract

Abstract Background Pulmonary vein isolation (PVI) is the most effective therapy to achieve rhythm control in atrial fibrillation (AF). Yet, data regarding the safety and effectiveness of this procedure in left common pulmonary vein (LCPV) variant is limited. Purpose To explore the effectiveness of cryoballoon AF ablation in patients with LCPV variant. Methods A prospective cohort, based on a multicenter registry that included patients who underwent PVI during the years 2019-2021. The study end points were acute isolation success of the pulmonary veins (PVs), AF recurrence and the need for a repeat ablation procedure at 12 months. Results Seventy-four patients with LCPV variant and 822 patients with standard four pulmonary veins (PVs) were included in the study cohort. The acute isolation success rates of the left pulmonary veins were significantly lower in the LCPV variants compared to the standard 2 left PVs; 95.9% versus 98.9% respectively (P=0.03). The acute isolation success rates of the right pulmonary veins were not different among patients with LCPV versus standard anatomy; 98.6% versus 98.5% respectively (P=0.9). The rates of AF recurrence at 12 months were numerically higher in the LCPV variant compared to the standard anatomy group; 17.6% versus 11.1% respectively, but did not reach statistical significance (P=0.09) (Figure 1). The rates of repeat ablation did not differ between the study groups; 8.1% versus 6.2% respectively (P=0.51) (Figure 2). Conclusion In our study cohort, the acute isolation success rate of the LCPV was significantly lower compared to standard two left PVs, this finding emphasizes the challenge of isolating LCPV variants using cryoballoon PVI. However, in spite of the lower isolation success rates in the LCPV variants, the clinical effectiveness to prevent AF recurrences was preserved.Figure 1Figure 2