Comparison of Using Second-Generation Cryoballoon and Radiofrequency Catheter for Atrial Fibrillation Ablation in Patients With the Common Ostium of Inferior Pulmonary Veins

Abstract

Aims: To compare the procedural outcomes of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in atrial fibrillation (AF) patients with the common ostium of inferior pulmonary veins (COIPV) and to explore the effect of COIPV on CBA performance through the assessment of anatomical factors.Methods: A total of 18 AF patients with COIPV were included. Pulmonary vein isolation (PVI) was performed with second-generation CBA or RFA. The anatomical characteristics of COIPV and procedural outcomes were collected.Results: The prevalence of COIPV was 0.82% in the enrolled population. PVI was achieved in all pulmonary veins (PVs) without any complications. The “tricircle” strategy was applied for RFA, and the segmental freeze strategy was performed for CBA. Compared with RFA, CBA had shorter procedural time (median: 53.0 vs. 78.0 min, p < 0.001) and longer fluoroscopy time (median: 13.5 vs. 6.0 min, p < 0.001). Higher ovality index of the ostium was seen in patients with ≥4 freezes in inferior PVs [IPVs; 0.95 (0.78–1.05) vs. 0.49 (0.21–0.83), p = 0.047]. During a median of 23.5 months of follow-up, the atrial arrhythmias-free survival after the procedure was comparable between CBA and RFA (p = 0.729).Conclusion: The second-generation CBA is an efficient and safe alternative for RFA in AF patients with COIPV. Anatomical characteristics of COIPV bring the challenge to the procedure performance of RFA and CBA.

Single ring isolation of pulmonary veins combined with electrical isolation of the superior vena cava in patients with paroxysmal atrial fibrillation

“…It is rare but challenging for PVI ablation ( 28 , 29 ). Yu et al ( 28 ) used the “tri-circle” strategy to finish the circumferential PV isolation, and Li et al ( 30 ) used the second-generation cryoballoon at the ostium of the left and right inferior pulmonary veins. The above methods inevitably increase the ablation dosing of LAPW.…”

Pulsed field ablation in common inferior pulmonary trunk

“…CIPT is a rare variant affecting less than 1% of patients undergoing ablation for atrial fibrillation [ 1 , 2 ]. In such patients, both inferior pulmonary veins drain via a common trunk.…”

“…Consequently, the esophagus is in contact inferiorly, posteriorly, and superiorly with CIPT. Hence, ablation with thermal energy exposes such patients to an increased risk of atrioesophageal fistula [ 1 ]. Because of the higher risk of fistula, some authors have elected to not isolate the CIPT when found during a radiofrequency pulmonary vein isolation procedure [ 2 ].…”