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Nagy LT, Papp TB, Urbancsek R, Jenei C, Csanadi Z. Right superior pulmonary vein parameter determined by three-dimensional transesophageal echocardiography is an independent predictor of the outcome after cryoballoon isolation of the pulmonary veins. Cardiol J 2023; 30:1010-1017. [PMID: 37853823 PMCID: PMC10713212 DOI: 10.5603/cj.95381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A direct comparison of three-dimensional transesophageal echocardiography (3DTEE) and cardiac computed tomography imaging has demonstrated good inter-technique agreement for the following pulmonary vein (PV) parameters: the ostium area of the right superior PV (RSPV) and its major (a) and minor axis (b) diameters, the left lateral ridge and the minor axis (b) diameter of the left superior PV. Herein, under investigation, was the predictive value of these parameters for arrhythmia recurrence (AR) after PV isolation with the 28 mm second generation cryoballoon (CBG2). METHODS One hundred eleven patients (67 men, mean age 58.06 ± 10.58 years) undergoing 3DTEE before PV isolation with the CBG2 for paroxysmal atrial fibrillation were followed. "Point by point" redo intervention was offered in case of AR and reconnected PVs were defined. RESULTS During a mean follow-up of 617 ± 258.86 days, 65 (58.9%) patients remained free of AR. Longer RSPV b was found to be the only significant predictor for AR (hazard ratio [HR] 1.059; 95% confidence interval [CI] 1.000-1.121; p = 0.048). RSPV b ≥ 28 mm resulted in a threefold (HR 3.010; 95% CI 1.270-7.134, p = 0.012) increase in the risk of AR. The association of RSPV b with AR was independent of the biophysical parameters of cryoapplications. In 25 "redo" patients, reconnections were found 1.75 times more likely in the RSPV than in the other 3 PVs altogether. CONCLUSIONS Right superior PV b measured with 3DTEE might be a significant predictor of AR after PV isolation with the CBG2. In case of RSPV b exceeding 28 mm, alternative PV isolation techniques or use of a larger balloon might be considered.
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Affiliation(s)
- Laszlo Tibor Nagy
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Timea Bianka Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Reka Urbancsek
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanadi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Benali K, Lai VD, Hammache N, Magnin-Poull I, de Chillou C, Sellal JM. Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters. J Interv Card Electrophysiol 2022; 66:931-940. [PMID: 36251129 DOI: 10.1007/s10840-022-01393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pulmonary vein (PV) isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF). PVI durability is influenced by many factors including PVs anatomy. Data regarding the influence of PVs anatomical variations on the outcomes of PAF ablation in the era of contact force-sensing ablation catheters are scarce and contradictory. METHODS Consecutive patients referred to our center for a first ablation of PAF using radiofrequency (RF) were included. PVs anatomy was classified into 3 groups: typical anatomy (4 distinct veins), left common ostium (LCO), and right accessory PV (RAPV). The primary outcome was recurrence of atrial arrhythmia episode during a 12-month follow-up after ablation. RESULTS Two hundred twenty-three patients were included (mean age 58.4 ± 10.8 years and 70.9% male). Among this cohort, 141 patients (63.2%) had typical PV anatomy, 53 (23.8%) had a LCO, and 29 (13.0%) had a RAPV. The existence of a RAPV was not associated with a higher rate of AF recurrences (22 (14.3%) vs. 7 (10.1%), p = 0.519). After multivariate analysis, the presence of an LCO did not appear to be associated with the AF recurrence rate at 12 months (OR = 1.69, 95%CI 0.95-2.49, p = 0.098). Maintenance of antiarrhythmic drugs after ablation was the only factor independently associated with a decreased risk of AF recurrence at 12 months (OR = 0.76, 95%CI 0.60-0.97, p = 0.046). CONCLUSION This study suggests that the presence of an LCO or a RAPV is not associated with a higher rate of AF recurrence at 12 months after radiofrequency PVI using contact force-sensing catheters in PAF patients.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, CHU de Saint-Etienne, 42270, Saint-Priest-En-Jarez, France. .,INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.
| | - Van Duc Lai
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Nefissa Hammache
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Isabelle Magnin-Poull
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Christian de Chillou
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Jean-Marc Sellal
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
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Benali K, Da Costa A, Macle L, Hammache N, Galand V, Romeyer C, Guichard JB, Leclercq C, Pavin D, Martins R. Distance between the descending aorta and the left inferior pulmonary vein as a determinant of biophysical parameters during paroxysmal atrial fibrillation cryoablation. J Cardiovasc Electrophysiol 2021; 32:2943-2952. [PMID: 34455655 DOI: 10.1111/jce.15234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The distance from the descending aorta (DA) to the posterior wall of the left atrium (LA) is variable. We aimed to determine whether the proximity between the DA and the left inferior pulmonary vein (LIPV) ostium has an impact on biophysical parameters and cryoballoon (CB) ablation efficacy during LIPV freezing. METHODS Patients referred for CB-ablation of atrial fibrillation (AF) in two high-volume centers were included. Cryoablation data were collected prospectively for each patient. The anatomical relationships between the LIPV and the DA (distance LIPV ostium-DA, presence of an aortic imprint on the posterior aspect of the LIPV) were then retrospectively analysed on the LA computed tomography scans realized before AF ablation. RESULTS A total of 350 patients were included (70% men, 59.7 ± 11.5 years). The decrease in the Ostium-DA distance was significantly correlated to the increase in the time-to-isolation (TTI) (r = -.31; p = .036), with less negative temperature (r = -.11; p = .045). Similarly, the presence of an aortic imprint on the LIPV was associated with a longer TTI (p < .001). The analysis of redo procedures data shows a trend toward the presence of shorter ostium-DA distances (15.3 ± 3.29 vs. 18.1 ± 4.99, p = .15) and more frequent aortic imprints (63.6% vs. 47.5%, p = .34) in patients with LIPV reconnection as opposed to patients without reconnection in the LIPV. CONCLUSION Our findings indicated that the DA seems to have a "radiator" effect influencing LIPV cryoablation parameters during CB-ablation. Additional studies will be needed to elucidate whether this biophysical influence has a clinical impact in LIPVs reconnections.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France.,University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Montreal, Canada
| | - Nefissa Hammache
- University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre lès-Nancy, France
| | - Vincent Galand
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Cécile Romeyer
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Jean Baptiste Guichard
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | | | - Dominique Pavin
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Raphaël Martins
- Department of Cardiology, Rennes University Hospital, Rennes, France.,University of Rennes, CHU Rennes, INSERM-LTSI, U1099, Rennes, France
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