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

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 wa...

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Published in:Clinical cardiology (Mahwah, N.J.) N.J.), 2019-04, Vol.42 (4), p.438-443
Main Authors: Mulder, Bart A., Al‐Jazairi, Meelad I. H., Arends, Bauke K. O., Bax, Niels, Dijkshoorn, Leonard A., Sheikh, Uzaifa, Tan, Eng S., Wiesfeld, Ans C. P., Tieleman, Robert G., Vliegenthart, Rozemarijn, Rienstra, Michiel, van Gelder, Isabelle C., Blaauw, Yuri
Format: Article
Language:English
Subjects:
anatomy
atrial fibrillation
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Cardiac arrhythmia
Clinical Investigations
computed tomography
cryoballoon ablation
Cryosurgery - methods
Electrocardiography, Ambulatory
Female
Follow-Up Studies
Heart Conduction System - physiopathology
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Multidetector Computed Tomography - methods
outcome
Pulmonary arteries
pulmonary veins
Pulmonary Veins - diagnostic imaging
Pulmonary Veins - surgery
Reproducibility of Results
Retrospective Studies
Tomography
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Summary: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. 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 PV 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.
ISSN:0160-9289
1932-8737
DOI:10.1002/clc.23163