Pulmonary vein anatomy addressed by computed tomography and relation to success of second-generation cryoballoon ablation in paroxysmal atrial fibrillation.

Abstract

BackgroundCryoballoon isolation is considered a safe and effective treatment for atrial fibrillation (AF). However, recurrence of AF after first cryoballoon ablation occurs in ~30% of patients. Pre‐procedurally identifying patients at risk of AF recurrence could be beneficial.HypothesisOur aim was to determine how pulmonary vein (PV) anatomy influences the recurrence of AF using the second‐generation cryoballoon in patients with paroxysmal AF.MethodsWe included 88 consecutive patients with paroxysmal AF undergoing PVI procedure with a second‐generation 28‐mm cryoballoon. All patients were evaluated at 3, 6 and 12 months using a 12‐lead ECG and 24‐hour Holter monitoring. PV anatomy was assessed by creating three‐dimensional models using computed tomography (CT) segmentations of the left atrium.ResultsFifty‐one patients (61%) had left PVs with a shared carina, 35 patients (42%) had a shared right carina. Nine patients (11%) were classified having a right middle PV. In total 17 (20.2%) of patients had a left common PV. At 12 months, 14 patients (17%) had experienced AF recurrence. Neither PV ovality, variant anatomy, the presence of shared carina nor a common left PV was a predictor for AF recurrence.ConclusionsNo specific characteristics of PV dimensions nor morphology were associated with AF recurrence after cryoballoon ablation in patients with paroxysmal AF.