Impact of an additional right pulmonary vein on second-generation cryoballoon ablation for atrial fibrillation: a propensity matched score study
Cryoballoon (CB) technology in the context of anatomical pulmonary vein (PV) variants might hypothetically hamper successful PV isolation (PVI). Our aim was to assess the impact of a right middle PV (RMPV) in the setting of second-generation cryoballoon (CB advance—CB-A), on procedural parameters and on mid-term follow-up.
Consecutive patients with AF presenting RMPV (RMPV+) at the pre-procedural computed tomography who underwent PVI by CB-A were enrolled. Comparison with propensity score-matched patients without RMPV (RMPV−) was performed. Acute procedural parameters and clinical follow-up were assessed.
A total of 240 patients (80 RMPV+) were included in the analysis. Twelve of 80 (15%) RMPV+ patients underwent a direct cryo-application in this variant and accomplished the isolation without phrenic nerve palsy, whereas in 25 of 80 (31%) RMPV+ patients, the RMPVs were not targeted directly nor indirectly (by co-occlusion during application at a major PV). At a median follow-up of 17.3 [interquartile range 11.3–26.5] months, there was no significant difference in AF-free survival between RMPV+ and RMPV− patients (78.8 vs 78.1%, P = 1.00), and the recurrence of atrial arrhythmias among patients with versus without an intentional or indirect cryo-application to the RMPV was not different (22 vs 20%, P = 1.00).
Mid-term outcome after CB-A ablation did not differ between RMPV+ and RMPV− patients. Within RMPV+ patients, outcome was similar between those with versus without a cryo-application (either direct or indirect) to the additional vein.
KeywordsAdditional pulmonary vein Second-generation cryoballoon Atrial fibrillation Pulmonary vein isolation
Compliance with ethical standards
Conflict of interest
Ken Takarada is currently receiving an educational grant from Japanese Heart Rhythm Society. Juan-Pablo Abugattas is currently receiving an educational grant from St. Jude medical for the Postgraduate in Cardiac electrophysiology and Pacing academic course. Carlo de Asmundis receive compensation for teaching purposes and proctoring from AF solutions, Medtronic, member steering committee ETNA-AF Europe Daiichi Sankyo Europe and research grants on behalf of the center from Biotronik, Medtronic, St Jude Medical Abbot, Livanova, Boston Scientific. Pedro Brugada receives speakers’ fees from Biotronik, Medtronic. Gian-Battista Chierchia receives compensation for teaching purposes and proctoring from AF solutions, Medtronic.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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