Abstract
Purpose
Pulmonary vein (PV) isolation using cryoballoon ablation (CBA) is a common therapy for patients with drug-refractory paroxysmal atrial fibrillation (PAF). However, initial CBA is successful in only 70–80% of patients. The role of an atypical left common PV (LCPV) and PV anatomical indices on CBA outcomes remains unclear.
Methods
We followed 80 patients (age 60.7 ± 9.7, 31 % women) with PAF undergoing CBA for 1-year post-procedure for the development of recurrent atrial arrhythmias (AA). Recurrence was assessed by documented AA on EKG or any form of long-term cardiac rhythm monitoring. The presence of an LCPV and individual PV diameters were evaluated using cardiac CT. Based on the maximum and minimum PV ostial diameters, the eccentricity index (EI), ovality index (OI), and PV ostial area (PVA) were calculated for all the veins. A multivariable Cox-proportional hazard model assessed whether the presence of an LCPV or PV anatomic indices (EI, OI, and PVA) predicted recurrence of AA following CBA.
Results
After 1-year follow-up, 19 (23.7%) participants developed recurrence of AA. On multivariable regression, the presence of an LCPV did not predict the recurrence of AA (p = 0.38). Among the PV anatomical indices, on univariate analysis, only the area of the left inferior PV showed a trend towards predicting recurrence, though this result was not significant on multivariate analysis (p = 0.09).
Conclusions
In patients with PAF, neither the presence of an LCPV nor individual PV anatomical indices predicted recurrence of AA following CBA.
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References
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14:e275–444.
Andrade JG, Champagne J, Dubuc M, Deyell MW, Verma A, Macle L, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomized clinical trial. Circulation. 2019;140:1779–88.
Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, et al. RAAFT-2 Investigators. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311:692–700.
Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012;367:1587–95.
Kubala M, Hermida JS, Nadji G, Quenum S, Traulle S, Jarry G. Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein. Pacing Clin Electrophysiol. 2011;34:837–43.
Sohns C, Sohns JM, Bergau L, Sossalla S, Vollmann D, Lüthje L, et al. Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation. Europace. 2013;15:1136–42.
Berruezo A, Tamborero D, Mont L, Benito B, Tolosana JM, Sitges M, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007;28:836–41.
Miyazaki S, Kuwahara T, Kobori A, Takahashi Y, Takei A, Sato A, et al. Catheter ablation of atrial fibrillation in patients with valvular heart disease: long-term follow-up results. J Cardiovasc Electrophysiol. 2010;21:1193–8.
Balk EM, Garlitski AC, Alsheikh-Ali AA, Terasawa T, Chung M, Ip S. Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review. J Cardiovasc Electrophysiol. 2010;21:1208–16.
Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110:364–7.
Providencia R, Adragao P, de Asmundis C, Chun J, Chierchia G, Defaye P, et al. Impact of body mass index on the outcomes of catheter ablation of atrial fibrillation: a European observational multicenter study. J Am Heart Assoc. 2019;8:e012253.
Sorgente A, Chierchia GB, de Asmundis C, Sarkozy A, Namdar M, Capulzini L, et al. Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation. Europace. 2011;13:205–12.
Schmidt M, Dorwarth U, Straube F, Daccarett M, Rieber J, Wankerl M, et al. Cryoballoon in AF ablation: impact of PV ovality on AF recurrence. Int J Cardiol. 2013;167:114–20.
McLellan AJ, Ling LH, Ruggiero D, Wong MC, Walters TE, Nisbet A, et al. Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2014;11:549–56.
Xu B, Xing Y, Xu C, Peng F, Sun Y, Wang S, et al. A left common pulmonary vein: anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30:717–26.
Kurokawa S, Nagashima K, Watanabe R, Arai M, Wakamatsu Y, Otsuka N, et al. Optimal diameter of the pulmonary vein ostium for second-generation 28-mm cryoballoon ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2020;43:201–9.
Schwartzman D, Bazaz R, Nosbisch J. Common left pulmonary vein: a consistent source of arrhythmogenic atrial ectopy. J Cardiovasc Electrophysiol. 2004;15:560–6.
Skowerski M, Wozniak-Skowerska I, Hoffmann A, Nowak S, Skowerski T, Sosnowski M, et al. Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation. BMC Cardiovasc Disord. 2018;18:146.
Tekbas G, Gumus H, Onder H, Ekici F, Hamidi C, Tekbas E, et al. Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography. Wien Klin Wochenschr. 2012;124:3–10.
Kaseno K, Tada H, Koyama K, Jingu M, Hiramatsu S, Yokokawa M, et al. Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. Am J Cardiol. 2008;101:1638–42.
Marom EM, Herndon JE, Kim YH, McAdams HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230:824–9.
Istratoaie S, Rosu R, Cismaru G, Vesa SC, Puiu M, Zdrenghea D, et al. The impact of pulmonary vein anatomy on the outcomes of catheter ablation for atrial fibrillation. Medicina (Kaunas). 2019;55:727.
Huang SW, Jin Q, Zhang N, Ling TY, Pan WQ, Lin CJ, et al. Impact of pulmonary vein anatomy on long-term outcome of cryoballoon ablation for atrial fibrillation. Curr Med Sci. 2018;38:259–67.
van der Voort PH, van den Bosch H, Post JC, Meijer A. Determination of the spatial orientation and shape of pulmonary vein ostia by contrast-enhanced magnetic resonance angiography. Europace. 2006;8:1–6.
Wittkampf FH, Vonken EJ, Derksen R, Loh P, Velthuis B, Wever EF, et al. Pulmonary vein ostium geometry: analysis by magnetic resonance angiography. Circulation. 2003;107:21–3.
Knecht S, Kuhne M, Altmann D, Ammann P, Schaer B, Osswald S, et al. Anatomical predictors for acute and mid-term success of cryoballoon ablation of atrial fibrillation using the 28 mm balloon. J Cardiovasc Electrophysiol. 2013;24:132–8.
Kajiyama T, Miyazaki S, Matsuda J, Watanabe T, Niida T, Takagi T, et al. Anatomic parameters predicting procedural difficulty and balloon temperature predicting successful applications in individual pulmonary veins during 28-mm second-generation cryoballoon ablation. JACC Clin Electrophysiol. 2017;3:580–8.
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The study was approved by the institutional review board for our institution. Since this was a retrospective chart review, no studies or interventions were performed on animals or humans.
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Bose, A., Chevli, P.A., Berberian, G. et al. Presence of a left common pulmonary vein and pulmonary vein anatomical characteristics as predictors of outcome following cryoballoon ablation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 62, 409–417 (2021). https://doi.org/10.1007/s10840-020-00916-6
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DOI: https://doi.org/10.1007/s10840-020-00916-6