Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation

Sohns, Christian; Sohns, Jan M; Bergau, Leonard; Sossalla, Samuel; Vollmann, Dirk; Lüthje, Lars; Staab, Wieland; Dorenkamp, Marc; Harrison, James; O’Neill, Mark; Lotz, Joachim; Zabel, Markus

doi:10.1093/europace/eut059

Cited by 45 publications

(46 citation statements)

References 23 publications

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“…For conventional RF‐based PVI in conjunction with 3D‐electroanatomical mapping, no negative impact on clinical outcomes in the presence of a LCPV was demonstrated and no correlation between PV‐diameters and long‐term clinical failure of PVI was found in two clinical studies . Contrarily to the latter studies, Sohns et al analysed data from 138 consecutive patients with AF referred for PVI with RF energy. With one‐year follow‐up, sinus rhythm was maintained after the initial ablation in 63% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Coutiño

Ströker

Takarada

et al. 2019

Pacing Clinical Electrophis

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Background A left common pulmonary vein (LCPV) accounts as the most frequent pulmonary vein (PV) variation. Our aim was to compare the performance of radiofrequency (RF) versus second‐generation cryoballoon (CB‐A) ablation in patients with atrial fibrillation (AF) and LCPVs. Methods In a total cohort of 716 patients undergoing PV isolation with preprocedural CT‐scanning, LCPV+ patients were selected with measurement of PV ostial area and trunk distance. All LCPV+ patients were matched between RF and CB‐A group in a 1:1 ratio based on propensity scores, and compared for outcome. Results Left common pulmonary veins were found in 31% (88/283) RF versus 34% (146/433) CB‐A patients, respectively, (P = .44). In the matched population of 83 LCPV+ patients in each group, electrical isolation could be achieved in all left‐sided PVs. No significant difference was noted for the rate of AF/left atrial tachyarrhythmia (LAT) recurrence between RF and CB‐A group (30% vs 28%, P = .86), with similar AF/LAT‐free survival (log rank, P = .71). There were 48 patients with AF/LAT recurrence (29%) during the follow‐up. Recurrence rate between paroxysmal versus persistent AF was 27/120 (22.5%) versus 21/46 (46%), P = .004. Cox proportional regression analysis withheld LA volume and persistent AF as independent variables to predict AF/LAT recurrence. No increased hazard for AF/LAT recurrence was observed for patients with a long (>15 mm) vs short (5‐15 mm) LCPV trunk (OR 1.14, 95% CI 0.6‐2.2, P = .7). Conclusions In our study, equal efficacy and outcome was noted in LCPV+ patients between RF and CB‐A technology.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Coutiño

Ströker

Takarada

et al. 2019

Pacing Clinical Electrophis

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“…Prior studies have investigated PV anatomy with focus on branching pattern, composition, size and ridges [15,16,27]. For comparison, McLellan, et al [16] describe in their study the dimensions of the PV ostia in a group of patients with AF with similar size distribution as in our study.…”

Section: Pulmonary Vein Cross-sectional Areamentioning

confidence: 59%

“…This widely accessible imaging modality may be used to provide a more detailed anatomical evaluation and road map before ablation, in terms of both LA and PV anatomy [3,[7][8][9][10][11][12]. Recent studies indicate that LA and PV characteristics as determined by cardiac MDCT are possible important predictors of AF recurrence after ablation therapy [11,[13][14][15][16], and that the thicker the parts of the LA are, the less successful ablation therapy becomes [13,17]. In addition, it has been found that patients with persistent AF have enlarged LA cavity, decreased left ventricular function and lower success rates than other patients referred for ablation [7,9,18,19].…”

Section: Left Atrial Wall Thickness (Lawt)mentioning

confidence: 99%

“…No association was found between PV CSA and duration (years of AF), type of AF (paroxysmal or persistent) or type of ablation (firsttime or repeat) ( Table 1, Table 2 We introduce novel information about to what extent the structure of the LA and PV anatomy is altered in AF patients compared to healthy subjects in sinus rhythm. Prior and larger population studies have described LA and PV anatomy in patients with AF [13][14][15][16]28,29].…”

Section: Pulmonary Vein Cross-sectional Areamentioning

confidence: 99%

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Left Atrial Wall Thickness and Pulmonary Vein Size are Increased in Patients with Atrial Fibrillation Compared to Healthy Controls - A Multidetector Computed Tomography Study

Thomsen¹

2017

Int J Clin Cardiol

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“…[7][8][9] The association between an LCPV and the outcome of the initial RFCA of AF was also explored by several studies which reported conflicting results. 5,6,[10][11][12] However, to our knowledge, whether or not an LCPV has an influence on the outcome of repeated RFCA for AF has never been discussed and the current study aims to fill in the gap.…”

mentioning

confidence: 99%

A left common pulmonary vein: Anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation

Xing

et al. 2019

Cardiovasc electrophysiol

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Introduction A left common pulmonary vein (LCPV) is a common anatomical variant in atrial fibrillation (AF) patients. Whether an LCPV influences outcomes of repeated radiofrequency catheter ablation (RFCA) for AF has not been elucidated. Methods From a prospectively collected database, we enrolled 154 patients who received repeated RFCA for recurrent AF after the initial RFCA (56 ± 9 years, 72% paroxysmal AF, 32 patients with an LCPV, and 122 patients with typical left‐sided pulmonary veins [PVs]). Median postprocedural follow‐up was 26 months. The primary outcome was an episode of AF, atrial tachyarrhythmia, or atrial flutter lasting for more than 30 seconds, after the 3 months blanking period following the repeated procedure. Results After the follow‐up period, 75 patients suffered recurrence after repeated ablation. In the Kaplan‐Meier analysis, an LCPV was significantly associated with less recurrence (hazard ratio [HR]: 0.39; 95% confidence interval [CI]: 0.28‐0.79; P = 0.005). In subgroup analysis, the significant association persisted in paroxysmal AF patients. Regarding persistent AF patients, an LCPV tended to be associated with less recurrence with no statistical significance (HR: 0.40; 95% CI: 0.20‐1.03; P = 0.067). In multivariate analyses, an LCPV still independently predicted freedom from recurrence (HR: 0.44; 95% CI: 0.22‐0.88; P = 0.02). Conclusion Compared with typical left‐sided PVs, an LCPV was independently associated with better outcomes after repeated RFCA of AF, particularly in patients with paroxysmal AF.

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Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation

Abstract: Pulmonary vein anatomy assessed by MDCT is a good predictor of AF recurrence after PVA using RMN.

Cited by 45 publications

References 23 publications

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Left Atrial Wall Thickness and Pulmonary Vein Size are Increased in Patients with Atrial Fibrillation Compared to Healthy Controls - A Multidetector Computed Tomography Study

A left common pulmonary vein: Anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation

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