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

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; Gelder, Isabelle C. Van; Blaauw, Yuri

doi:10.1002/clc.23163

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…They recommend the use of a 28 mm balloon since it allows a wider antral PVI use for both a common ostium and for encompassing accessory veins. Consistent with these findings is a recent study of Mulder et al [25] that has not found a difference between the typical 4 PV conformation and the other anatomical variants in AF recurrence rate at 12 months follow-up after second-generation cryobaloon ablation use in patients that obtain a AF post-ablation prognosis.…”

Section: Discussionsupporting

confidence: 83%

The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation

et al. 2019

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Background and Objectives: Prior studies have identified a number of predictors for Atrial fibrillation (AF) ablation success, including comorbidities, the type of AF, and left atrial (LA) size. Ectopic foci in the initiation of paroxysmal AF are frequently found in pulmonary veins. Our aim was to assess how pulmonary vein anatomy influences the recurrence of atrial fibrillation after radiofrequency catheter ablation. Materials and Methods: Eighty patients diagnosed with paroxysmal or persistent AF underwent radiofrequency catheter ablation (RFCA) between November 2016 and December 2017. All of these patients underwent computed tomography before AF ablation. PV anatomy was classified according to the presence of common PVs or accessory PVs. Several clinical and imagistic parameters were recorded. After hospital discharge, all patients were scheduled for check-up in an outpatient clinic at 3, 6, 9, and 12 months after RFCA to detect AF recurrence. Results: A total of 80 consecutive patients, aged 53.8 ± 9.6 years, 54 (67.5%) men and 26 (32.5%) women were enrolled. The majority of patients had paroxysmal AF 53 (66.3%). Regular PV anatomy (2 left PVs, 2 right PVs) was identified in 59 patients (73.7%), a left common trunk (LCT) was detected in 15 patients (18.7%), an accessory right middle pulmonary vein (RMPV) was found in 5 patients (6.25%) and one patient presented both an LCT and an RMPV. The median follow-up duration was 14 (12; 15) months. Sinus rhythm was maintained in 50 (62.5%) patients. Age, gender, antiarrhythmic drugs, and the presence of cardiac comorbidities were not predictive of AF recurrence. The diagnosis of persistent AF before RFCA was more closely associated with an increase in recurrent AF after RFCA than after paroxysmal AF (p = 0.01). Longer procedure times (>265 min) were associated with AF recurrence (p = 0.04). Patients with an LA volume index of over 48.5 (mL/m2) were more likely to present AF recurrence (p = 0.006). Multivariate analysis of recurrence risk showed that only the larger LA volume index and variant PV anatomy were independently associated with AF recurrence. Conclusion: The study demonstrated that an increased volume of the left atrium was the most important predictive factor for the risk of AF recurrence after catheter ablation. Variant anatomy of PV was the only other independent predictive factor associated with a higher rate of AF recurrence.

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Section: Discussionsupporting

confidence: 83%

The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation

et al. 2019

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“…No relationship with anatomy (PV ovality, the presence of anatomical variants (right middle PVs, common ostia), shared carina nor carina width). 14 .…”

Section: Resultsmentioning

confidence: 99%

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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“…Another report demonstrates that ventral-caudal orientation of both the LSPV and LIPV is significantly associated with AF recurrence [16]. Contrarily, Mulder et al observed no specific characteristics of PV dimensions or morphology associated with AF recurrence after cryoablation [33]. Only a few recent studies investigated the association between PV anatomy and procedural cooling kinetics during CBA.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulmonary vein ovality index on cooling kinetics and acute success of atrial fibrillation ablation with the third-generation cryoballoon catheter

Stachyra¹,

Szczasny²,

Tarkowski³

et al. 2021

pwki

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

Cited by 15 publications

References 21 publications

The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation

The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation

Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

Impact of pulmonary vein ovality index on cooling kinetics and acute success of atrial fibrillation ablation with the third-generation cryoballoon catheter

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