Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score

Vaishnav, Aditi S; Alderwish, Edris; Coleman, Kristie; Saleh, Moussa; Makker, Parth; Bhasin, Kabir; Bernstein, Neil E.; Skipitaris, Nicholas; Mountantonakis, Stavros

doi:10.1007/s10840-020-00799-7

Cited by 9 publications

(13 citation statements)

References 24 publications

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“…Score consists of RSPV ovality index >1.32, LSPV ovality index >1.2, RSPV antral circumference >69.1 mm, RIPV antral circumference >61.38 mm, RSPV >22.7°, LA diameter and right middle PV. 13 …”

Section: Resultsmentioning

confidence: 99%

“…One article showed a score for predicting unfavourable left atrium and PV anatomy. 13 The score consists of seven factors: (1) RSPV ovality index >1.32; (2) LSPV ovality index >1.2; (3) RSPV antral circumference >69.1 mm; (4) RIPV antral circumference >61.38 mm; (5) RSPV >22.7°, which was defined as the angle from the horizontal line to the RSPV on the coronal view; (6) left atrium diameter >43.5 mm and (7) presence of the right middle PV. They reported that patients with scores ≥4 required longer cryoapplication times (p=0.002) and more frequent switching to radiofrequency catheters (p=0.066) to achieve PVI than those with scores <4.…”

Section: Resultsmentioning

confidence: 99%

“…One article reported an association between bronchial damage and anatomy. Wei et al reported that left main bronchus-LSPV ostium distance was a predictor 13 2. Score of ≥4 predicted needs for longer cryoenergy ablation.…”

Section: Bronchial Damagementioning

confidence: 99%

“…Score of ≥4 predicted needs for longer cryoenergy ablation. 13 No association between anatomy and AF recurrence 1. No relationship with anatomy (PV ovality, the presence of anatomical variants (right middle PVs, common ostia), shared carina nor carina width).…”

Section: Bronchial Damagementioning

confidence: 99%

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Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

et al. 2022

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BackgroundThe limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic analysis on procedural success rate, atrial fibrillation (AF) recurrence rate and complications of cryoballoon ablation in association with the anatomy of the left atrium and PV based on preprocedural CT to gain insights into proper treatments of patients with AF using cryoballoon.MethodA systematic search of literature databases, including PubMed, Web of Science and Cochrane Library, from the inception of each database through February 2021 was conducted. Search keywords included ‘atrial fibrillation’, ‘cryoballoon ablation’ and ‘anatomy’.ResultsOverall, 243 articles were identified. After screening, 16 articles comprising 1396 patients were included (3, 5 and 8 for acute success, AF recurrence and complications, respectively). Regarding acute success and AF recurrences, thinner width of the left lateral ridge, higher PV ovality, PV ostium-bifurcation distance, shorter distance from the non-coronary cusp to inferior PVs, shallower angle of right PVs against the atrial septum and larger right superior PV (RSPV) were associated with poor outcomes. Regarding complications, shorter distance between the RSPV ostium and the right phrenic nerve, larger RSPV-left atrium angle, larger RSPV area and smaller right carina width were associated with incidences of phrenic nerve injury.ConclusionThis study elucidated several key anatomical features of PVs possibly affecting acute success, AF recurrence and complications in patients with AF using cryoballoon ablation. CT analysis has helped to describe benefits and anatomical limitations for cryoballoon ablation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Bronchial Damagementioning

confidence: 99%

Section: Bronchial Damagementioning

confidence: 99%

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Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

et al. 2022

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“…A group of American researchers followed the path of an integrated approach for the assessment of the anatomical factor and proposed in 2020 a generalized model for assessing the ‘favorable’ and ‘unfavorable’ anatomy of the LA and PV based on CT data [ 24 ]. The model included the following factors: oval LSPV and RSPV, large circumference of the RSPV and RIPV ostia, RSPV tilt angle more than 22.7 degrees, atriomegaly (LA diameter more than 4.35 cm), and the presence of an accessory right PV.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results

et al. 2022

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The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atrial fibrillation (AF). We compared procedural and long-term outcomes in patients who underwent their first procedure of pulmonary vein isolation (PVI) for AF with either radiofrequency ablation (RFA) (n = 108) or CBA (n = 122) and assessed their interaction with the different pattern of PV anatomy, morphometric characteristics, and spatial orientation. The primary efficacy endpoint was any documented atrial arrhythmia recurrence (AF, atrial flutter, or atrial tachycardia) lasting over 30 s during a 12-month follow-up after a 90-day blanking period and discontinuation of antiarrhythmic drugs. The procedure’s endpoint was the achievement of PVI. Before the intervention, all patients underwent computed tomography (CT) to assess the PV anatomical variant, maximum and minimum diameters of the PV’s ostia, their cross-sectional area, orifice ovality index, and PV tilt angles. Results: The mean follow-up period was 14 months (12; 24). Long-term efficacy in the cryoablation group was 78.8% and in the RFA group—83.3% (OR = 0.74; 95% CI 0.41–1.3; p = 0.31). The RFA results did not depend on PV anatomy. The «difficult» occlusion of the right inferior PV (RIPV) occurred in 12 patients and was associated with a more horizontal PV position in the frontal plane; the mean tilt angle was −15.2 ± 6.2° versus −26.5 ± 6.3° in the absence of technical difficulties (p = 0.0001). In 11 cases (9%), during ablation of the right superior PV (RSPV), phrenic nerve injury (PNI) occurred and was associated with the maximum and minimum RSPV diameter, 20.0–20.4 mm (OR = 13.2; 95% CI: 4.7–41.9, p < 0.05) and 17.5–20 mm (OR = 12.5; 95% CI 3.4–51, p < 0.05), respectively. Patients with arrhythmia recurrence were characterized by significantly larger diameters and ovality of the left superior PV (LSPV). The spatial orientation of the PV does not affect the long-term results of cryoablation. Conclusion: Preprocedural evaluation of PV morphology and orientation using cardiac CT might help choose the optimal technology for the individual patient.

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Voltage Map Guided Nonocclusive Balloon Cryoablation to Achieve Antral Pulmonary Vein Isolation

Coleman

Atteya

Varrias

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score

Cited by 9 publications

References 24 publications

Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results

Voltage Map Guided Nonocclusive Balloon Cryoablation to Achieve Antral Pulmonary Vein Isolation

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