Presence of a left common pulmonary vein and pulmonary vein anatomical characteristics as predictors of outcome followin
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Presence of a left common pulmonary vein and pulmonary vein anatomical characteristics as predictors of outcome following cryoballoon ablation for paroxysmal atrial fibrillation Abhishek Bose 1 & Parag A. Chevli 2 & Gregory Berberian 3 & Jerzy Januszkiewicz 3 & Ghasan Ahmad 4 & Zeba Hashmath 5 & Ajay K. Mishra 5 & Douglas Laidlaw 1 Received: 7 August 2020 / Accepted: 10 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose 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 We followed 80 patients (age 60.7 ± 9.7, 31 % women) with PAF undergoing CBA for 1-year post-procedure for the development of recurrent atrial arrhythmias (AA). Recurrence was assessed by documented AA on EKG or any form of longterm 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. Results After 1-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). Conclusions In patients with PAF, neither the presence of an LCPV nor individual PV anatomical indices predicted recurrence of AA following CBA. Keywords Paroxysmal atrial fibrillation . Cryoballoon ablation . Left common pulmonary vein . Pulmonary vein anatomy
1 Introduction
* Abhishek Bose [email protected] 1
Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01604, USA
2
Section of Hospital Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
3
Department of Radiology, Saint Vincent Hospital, Worcester, MA, USA
4
Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
5
Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
Pulmonary vein isolation (PVI) with radiofrequency (RF) or cryoballoon ablation (CBA) is a common therapy for patients with drug-refractory paroxysmal atrial fibrillation (AF).[1] However, studies have reported the success rate of ablation to be around 70–80% after 1 year of follow-up.[2–4] The exact etiology for certain patients not benefiting from this procedure remains unclear but likely includes pulmonary
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