Pulmonary vein anatomy and its variations in a Turkish atrial fibrillation cohort undergoing cryoballoon-based catheter ablation

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

PURPOSE

Cryoballoon (CB) and radiofrequency (RF) ablation techniques have similar outcomes for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). However, there is limited data about the impact of different ablation strategies in patients with left common pulmonary vein (LCPV). Our aim was to compare the safety and efficacy of RF and CB ablation in AF patients with LCPV.

METHODS

One hundred and twenty-seven (n = 80 CB and n = 47 RF) AF patients with LCPV detected by preprocedural computerized tomography (CT) were included in the study. Ostial dimensions and trunk distance were measured in all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period.

RESULTS

There was no significant difference in acute procedural success rates for PVI (97.5% in CB and 97.9% in RF, respectively, P = 0.953) and complication rates were similar between the groups (6 (7.5%) in CB and 4 (8.5%) in RF, respectively, P = 1.000). During a median follow-up of 20.7 (4.8-50.2) months for CB and 20.5 (6.2-36.0) months for RF, ATa recurrence was 35.0% and 38.2%, respectively (P = 0.777). Multivariate analysis did not reveal any of the morphologic parameters of LCPV as a significant predictor of ATa recurrence.

CONCLUSIONS

Our findings demonstrated that both CB and RF ablation techniques have similar efficacy and safety in AF patients with LCPV during the mid-term follow-up.

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

PURPOSE

The efficacy of cryoballoon (CB) for atrial fibrillation (AF) ablation is still debatable in case of anatomical variations like left common pulmonary vein (LCPV). We aimed to assess the impact of LCPV trunk on the acute and long-term clinical outcomes in patients with CB based AF ablation.

METHODS

We compared a total of 82 AF patients (62.5% paroxysmal and 37.5% persistent) who underwent pulmonary vein isolation using CB (LCPV+ group) with a propensity score-matched cohort of 76 AF patients (LCPV- group) (61.8% paroxysmal and 38.2% persistent). Preprocedural computed tomography was performed in all patients and ostial dimensions and trunk distance were measured. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period.

RESULTS

Acute procedural success was similar between the groups (100% and 98.7% for LCPV- and LCPV+, respectively, P = 0.991). Overall, 22/76 (28.9%) patients in LCPV- and 21/82 (25.6%) patients in LCPV+ had ATa recurrence at a mean follow-up of 31 ± 15 months (P = 0.770). A multivariate analysis identified only the left atrial (LA) diameter as a predictor of recurrent ATs (HR, 3.28; 95% CI, 1.67-6.41; P = 0.001). In the LCPV+ group, patients with single application had higher ATa recurrence (8/18 patients) compared with sequential freeze group (13/64 patients) (P = 0.042).

CONCLUSIONS

Our findings indicated that CB was an effective tool in patients with LCPV and freedom from ATa was similar between LCPV- and LCPV+ groups. Only LA diameter predicted the ATa recurrence during long-term follow-up.