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Anatomical predictors for successful pulmonary vein isolation using balloon-based technologies in atrial fibrillation

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Abstract

Purpose

We evaluated the correlation between pulmonary venous (PV) anatomy and acute and long-term success of PV isolation (PVI) with two balloon-based ablation catheter techniques.

Methods

One hundred consecutive patients were analyzed in two equal groups treated with either the second-generation cryoballoon (CRYO) catheter or the visually guided laser ablation (VGLA) catheter. All patients underwent multi-detector computed tomography (CT) imaging. The primary and secondary efficacy endpoints were the procedural achievement of proven electrical isolation of all veins and freedom from atrial fibrillation (AF) within a 1-year follow-up period, respectively.

Results

Variant PV anatomy was observed in 32 % of patients in the CRYO group and in 40 % of patients in the VGLA group. All PVs were targeted with either the CRYO catheter (n = 199) or the VGLA catheter (n = 206). One hundred ninety-three of 199 PVs (97 %) were successfully isolated in the CRYO group and 194 of 206 PVs (94 %) in the VGLA group (p = 0.83). Over a 12-month follow-up, AF recurrence was documented in 11/45 (24 %) and 7/43 (16 %) patients in the CRYO and the VGLA groups, respectively (p = 0.21). In the CRYO group, a larger left inferior PV size was associated with worse long-term outcome (p = 0.001). In the VGLA group, a larger left superior PV size (p = 0.003) and more oval right inferior PV were associated with worse acute success (p = 0.038). There was no absolute cutoff between PV anatomy and clinical success.

Conclusions

The variability of PV anatomy did not significantly compromise acute success of PVI or patient outcomes.

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Authors and Affiliations

  1. Na Homolce Hospital, Prague, Czech Republic

    Alexey Tsyganov, Jan Petru, Jan Skoda, Lucie Sediva, Pavel Hala, Jiri Weichet, Marek Janotka, Milan Chovanec & Petr Neuzil

  2. Petrovsky National Research Centre of Surgery, Moscow, Russia

    Alexey Tsyganov

  3. The Helmsley Electrophysiology Centre, Mount Sinai School of Medicine, New York, NY, US

    Vivek Y. Reddy

Authors
  1. Alexey Tsyganov
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  2. Jan Petru
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  3. Jan Skoda
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  4. Lucie Sediva
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  5. Pavel Hala
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  6. Jiri Weichet
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  7. Marek Janotka
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  8. Milan Chovanec
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  9. Petr Neuzil
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  10. Vivek Y. Reddy
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Correspondence to Alexey Tsyganov.

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Tsyganov, A., Petru, J., Skoda, J. et al. Anatomical predictors for successful pulmonary vein isolation using balloon-based technologies in atrial fibrillation. J Interv Card Electrophysiol 44, 265–271 (2015). https://doi.org/10.1007/s10840-015-0068-3

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  • DOI: https://doi.org/10.1007/s10840-015-0068-3

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