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

Meelad I H Al‐Jazairi,Eng S Tan,Bart A Mulder,Rozemarijn Vliegenthart,Niels Bax,Ans C P Wiesfeld,Michiel Rienstra,Yuri Blaauw,Bauke K O Arends,Uzaifa Sheikh,Robert G Tieleman,Leonard A Dijkshoorn,Isabelle C Van Gelder

doi:10.1002/clc.23163

Meelad I H Al‐Jazairi, Eng S Tan + Show 11 more

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https://doi.org/10.1002/clc.23163

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Journal: Clinical cardiology	Publication Date: Mar 13, 2019
Citations: 11	License type: CC BY 4.0

Affiliation: University of Groningen

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.

Highlights

Ablation outcome may be affected by clinical factors, such as type of atrial fibrillation (AF), left atrial (LA) size, comorbidities or operator experience.[5,6]Atrial fibrillation (AF) is the most encountered arrhythmia in clinical Besides these clinical characteristics, it has been suggested that pulmonary vein (PV) practice
We explored whether specific characteristics of PV dimension or anatomy could predict outcome of cryoballoon ablation in patients with paroxysmal AF
As pulmonary vein isolation (PVI) outcome is difficult to predict because of many confounding factors, we limited our analysis to a homogenous patient population and reproducible ablation procedure, that is, paroxysmal AF patients treated with a 28-mm second-generation cryoballoon

Summary

Background

Cryoballoon isolation is considered a safe and effective treatment for atrial fibrillation (AF). Recurrence of AF after first cryoballoon ablation occurs in ~30% of patients. Hypothesis: Our aim was to determine how pulmonary vein (PV) anatomy influences the recurrence of AF using the second-generation cryoballoon in patients with paroxysmal AF. Methods: We included 88 consecutive patients with paroxysmal AF undergoing PVI procedure with a second-generation 28-mm cryoballoon. 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. Conclusions: No specific characteristics of PV dimensions nor morphology were associated with AF recurrence after cryoballoon ablation in patients with paroxysmal AF. KEYWORDS anatomy, atrial fibrillation, computed tomography, cryoballoon ablation, outcome, pulmonary veins

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