Pulmonary vein anatomy addressed by computed tomography and relation to success of second-generation cyroballoon ablation in paroxysmal atrial fibrillation

Bart A Mulder, Meelad I H Al-Jazairi, Bauke K O Arends, Niels Bax, Leonard A Dijkshoorn, Uzaifa Sheikh, Eng Shiong Tan, Ans C P Wiesfeld, Robert G Tieleman, Rozemarijn Vliegenthart, Michiel Rienstra, Isabelle C van Gelder, Yuri Blaauw

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BACKGROUND: Cryoballoon isolation is considered a safe and effective treatment for atrial fibrillation (AF). However, recurrence of AF after first cryoballoon ablation occurs in ~30% of patients. Pre-procedurally identifying patients at risk of AF recurrence could be beneficial.

HYPOTHESIS: Our aim was to determine how pulmonary vein (PV) anatomy influences the recurrence of AF using the second-generation cryoballoon in patients with paroxysmal AF.

METHODS: We included 88 consecutive patients with paroxysmal AF undergoing PVI procedure with a second-generation 28-mm cryoballoon. All patients were evaluated at 3, 6 and 12 months using a 12-lead ECG and 24-hour Holter monitoring. Pulmonary vein (PV) anatomy was assessed by creating three dimensional models using computed tomography (CT) segmentations of the left atrium.

RESULTS: Fifty-one patients (61%) had left PVs with a shared carina, 35 patients (42%) had a shared right carina. Nine patients (11%) were classified having a right middle PV. In total 17 (20.2%) of patients had a left common PV. At 12 months, 14 patients (17%) had experienced AF recurrence. Neither PV ovality, variant anatomy, the presence of shared carina nor a common left pulmonary vein was a predictor for AF recurrence.

CONCLUSIONS: No specific characteristics of PV dimensions nor morphology were associated with AF recurrence after cryoballoon ablation in patients with paroxysmal AF. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)438-443
Number of pages6
JournalClinical Cardiology
Issue number4
Publication statusPublished - Mar-2019

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