Presence of a Left Common Pulmonary Vein and Pulmonary Vein Anatomical
Characteristics as Predictors of Outcome Following Cryoballoon Ablation
for Paroxysmal Atrial Fibrillation
Abstract
Introduction: Pulmonary vein (PV) isolation using cryoballoon
ablation (CBA) is a common therapy for patients with drug refractory
paroxysmal atrial fibrillation (PAF). However, initial CBA is successful
in only 70-80% of patients. The role of an atypical left common PV
(LCPV) and PV anatomical indices on CBA outcomes remains unclear.
Methods and Results: We followed 80 patients (age 60.7 ± 9.7, 31
% women) with PAF undergoing CBA for one-year post-procedure for the
development of recurrent atrial arrhythmias (AA). Recurrence was
assessed by documented AA on EKG or any form of long-term cardiac rhythm
monitoring. The presence of an LCPV and individual PV diameters were
evaluated using cardiac CT. Based on the maximum and minimum PV ostial
diameters, the eccentricity index (EI), ovality index (OI), and PV
ostial area (PVA) were calculated for all the veins. A multivariable
cox-proportional hazard model assessed whether the presence of an LCPV
or PV anatomic indices (EI, OI and PVA) predicted recurrence of AA
following CBA. After one year follow up, 19 (23.7%) participants
developed recurrence of AA. On multivariable regression, the presence of
an LCPV did not predict the recurrence of AA (p = 0.38). Among the PV
anatomical indices, on univariate analysis, only the area of the left
inferior PV showed a trend towards predicting recurrence, though this
result was not significant on multivariate analysis (p = 0.09).
Conclusion: In patients with PAF, neither the presence of an LCPV
nor individual PV anatomical indices predicted recurrence of AA
following CBA.