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Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters

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Abstract

Background

Pulmonary vein (PV) isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF). PVI durability is influenced by many factors including PVs anatomy. Data regarding the influence of PVs anatomical variations on the outcomes of PAF ablation in the era of contact force-sensing ablation catheters are scarce and contradictory.

Methods

Consecutive patients referred to our center for a first ablation of PAF using radiofrequency (RF) were included. PVs anatomy was classified into 3 groups: typical anatomy (4 distinct veins), left common ostium (LCO), and right accessory PV (RAPV). The primary outcome was recurrence of atrial arrhythmia episode during a 12-month follow-up after ablation.

Results

Two hundred twenty-three patients were included (mean age 58.4 ± 10.8 years and 70.9% male). Among this cohort, 141 patients (63.2%) had typical PV anatomy, 53 (23.8%) had a LCO, and 29 (13.0%) had a RAPV. The existence of a RAPV was not associated with a higher rate of AF recurrences (22 (14.3%) vs. 7 (10.1%), p = 0.519). After multivariate analysis, the presence of an LCO did not appear to be associated with the AF recurrence rate at 12 months (OR = 1.69, 95%CI 0.95–2.49, p = 0.098). Maintenance of antiarrhythmic drugs after ablation was the only factor independently associated with a decreased risk of AF recurrence at 12 months (OR = 0.76, 95%CI 0.60–0.97, p = 0.046).

Conclusion

This study suggests that the presence of an LCO or a RAPV is not associated with a higher rate of AF recurrence at 12 months after radiofrequency PVI using contact force-sensing catheters in PAF patients.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AAD:

Antiarrhythmic drugs

AF:

Atrial fibrillation

PAF:

Paroxysmal atrial fibrillation

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

LA:

Left atrium

LVEF:

Left ventricular ejection fraction

CT:

Computed tomography

LCO:

Left common ostium

RAPV:

Right accessory pulmonary vein

RF:

Radiofrequency

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Acknowledgements

We would like to thank Arthur Kohler and Maxime Tissier for their contribution to this work.

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Author notes

  1. Karim Benali and Van Duc Lai contributed equally.

Authors and Affiliations

  1. Department of Cardiology, CHU de Saint-Etienne, 42270, Saint-Priest-En-Jarez, France

    Karim Benali

  2. INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France

    Karim Benali, Van Duc Lai, Nefissa Hammache, Isabelle Magnin-Poull, Christian de Chillou & Jean-Marc Sellal

  3. Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France

    Van Duc Lai, Nefissa Hammache, Isabelle Magnin-Poull, Christian de Chillou & Jean-Marc Sellal

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Correspondence to Karim Benali.

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Benali, K., Lai, V.D., Hammache, N. et al. Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters. J Interv Card Electrophysiol 66, 931–940 (2023). https://doi.org/10.1007/s10840-022-01393-9

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