Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common pulmonary vein anatomy

Yorgun, Hikmet; Canpolat, Uğur; Gümeler, Ekim; Okşul, Metin; Şener, Yusuf Ziya; Ateş, Ahmet Hakan; Akkaya, Fatih; Karahan, Sevilay; Hazırolan, Tuncay; Aytemir, Kudret

doi:10.1007/s10840-019-00676-y

Cited by 7 publications

(20 citation statements)

References 17 publications

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“…One of the studies used application of an implantable monitor and any atrial tachyarrhythmia (AF/TA) with a minimum duration of 120 s being used as the outcome, 17 while for the purpose of the analysis, the detection of clinical recurrence was considered using non‐invasive and invasive methods. In two studies, the suspension of antiarrhythmic drugs after the blanking period was at the discretion of the attending medical team, therefore, drug therapy may have been maintained during the clinical follow‐up of these studies 7,9 …”

Section: Resultsmentioning

confidence: 99%

“…As LCO usually has a wider ostium, it would be perhaps more difficult to have the complete antral occlusion, which justifies the less practical use of the standard approach 10 . Analyzing the sequential approach, the most used among the studies, the antral region is not reached by the balloon, especially in LCO with length >12 mm 6–8,10,15,18 . Consecutive ablation approach was previously suggested instead of the sequential ablation approach in the setting of large PV‐diameters.…”

Section: Discussionmentioning

confidence: 99%

“…For the assessment of the presence of the LCO in the clinical outcome of patients undergoing AF ablation (by RF or CRYO), 14 non-randomized studies totaling 3278 patients were included. [3][4][5][6][7][8][9][10][15][16][17][18][19]23 Eleven studies only used PV isolation as an ablation strategy associated with cavotricuspid isthmus block in the presence of atrial flutter. In the remaining three studies, linear ablations in the LA and RA were present in all of them, and in one of them, there was a mapping of fractional potentials with associated ablation.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…With the exception of the accessory PVs, the left common ostium (LCO) is the most common abnormality and can affect 37% of the population 3 . There are conflicting results in the literature concerning the effects of the presence of the LCO on the prognosis following AF ablation 2–19 …”

Section: Introductionmentioning

confidence: 99%

“…3 There are conflicting results in the literature concerning the effects of the presence of the LCO on the prognosis following AF ablation. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Comparisons of the effectiveness of the two ablation modalities (RF and CRYO) among patients with the LCO have already been published, however, a meta-analysis has the potential to optimize the statistical power and precision of the respective analyses. 15,17 Therefore, we conducted a systematic review and meta-analysis of studies that determined the pulmonary venous anatomy in patients undergoing AF ablation.…”

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confidence: 99%

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Impact of the left common ostium following pulmonary vein isolation in AF: Systematic review and meta‐analysis

Ronsoni

Silvestrini

Saffi

et al. 2022

Journal of Arrhythmia

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The extrasystoles of the pulmonary veins (PV) are the most significant trigger of atrial fibrillation (AF), and PV isolation through catheter ablation is the basis for the treatment of symptomatic AF and cases that are refractory to drug therapy. 1 The complete isolation of the veins in relation to the atrium is the desired outcome of the ablation and this can be achieved through radiofrequency energy (RF) (point-to-point or by linear lesions surrounding the veins under three-dimensional mapping) or by insertion of a cryoablation balloon (CRYO), with similar results experienced with the two techniques. 1 Despite the continuous evolution of ablation techniques, recurrence

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of the left common ostium following pulmonary vein isolation in AF: Systematic review and meta‐analysis

Ronsoni

Silvestrini

Saffi

et al. 2022

Journal of Arrhythmia

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Comparison of atrial fibrillation ablation using cryoballoon versus radiofrequency in patients with left common pulmonary veins: mid-term follow-up results

Çöteli

Dural

Şener

et al. 2021

J Interv Card Electrophysiol

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Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation

Szegedi

Vecsey-Nagy

Simon

et al. 2021

European Heart Journal - Cardiovascular Imaging

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Aims Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique. Methods and results We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P > 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15–2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19–0.71, P = 0.003). Conclusion Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.

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Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common pulmonary vein anatomy

Cited by 7 publications

References 17 publications

Impact of the left common ostium following pulmonary vein isolation in AF: Systematic review and meta‐analysis

Impact of the left common ostium following pulmonary vein isolation in AF: Systematic review and meta‐analysis

Comparison of atrial fibrillation ablation using cryoballoon versus radiofrequency in patients with left common pulmonary veins: mid-term follow-up results

Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation

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