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Presence of a left common pulmonary vein and pulmonary vein anatomical characteristics as predictors of outcome following cryoballoon ablation for paroxysmal atrial fibrillation

Journal of Interventional Cardiac Electrophysiology volume 62, pages 409–417 (2021)Cite this article

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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Author information

Affiliations

  1. Division of Cardiology, Saint Vincent Hospital, Worcester, MA, 01604, USA

    Abhishek Bose & Douglas Laidlaw

  2. Section of Hospital Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Parag A. Chevli

  3. Department of Radiology, Saint Vincent Hospital, Worcester, MA, USA

    Gregory Berberian & Jerzy Januszkiewicz

  4. Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA

    Ghasan Ahmad

  5. Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA

    Zeba Hashmath & Ajay K. Mishra

Authors
  1. Abhishek Bose
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  2. Parag A. Chevli
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  3. Gregory Berberian
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  4. Jerzy Januszkiewicz
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  5. Ghasan Ahmad
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  6. Zeba Hashmath
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  7. Ajay K. Mishra
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  8. Douglas Laidlaw
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Correspondence to Abhishek Bose.

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The authors declare they have no conflict of interest.

Ethical approval

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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Keywords

  • Paroxysmal atrial fibrillation
  • Cryoballoon ablation
  • Left common pulmonary vein
  • Pulmonary vein anatomy