Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common p
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Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common pulmonary vein anatomy Hikmet Yorgun 1,2 & Uğur Canpolat 1 & Ekim Gümeler 3 & Metin Okşul 1 & Yusuf Ziya Şener 1 & Ahmet Hakan Ateş 1 & Fatih Akkaya 1 & Sevilay Karahan 4 & Tuncay Hazırolan 3 & Kudret Aytemir 1 Received: 25 August 2019 / Accepted: 25 November 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract 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. Keywords Atrial fibrillation . Left common pulmonary vein . Cryoballoon . Common pulmonary trunk
1 Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-019-00676-y) contains supplementary material, which is available to authorized users. * Hikmet Yorgun [email protected] 1
Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230 Sıhhıye, Ankara, Turkey
2
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
3
Department of Radiology, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
4
Department of Biostatistics, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
Pulmonary vein isolation (PVI) has become a mainstay in invasive treatment of atrial fibrillation (AF). Because of shorter learning curve and similar efficacy and safety outcomes compar
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