Frontal right inferior pulmonary vein orientation (OR 1.13) and warmer balloon nadir temperature independently predicted late electrical reconnection after second-generation cryoballoon ablation.
Observational (n=129)
Do anatomic parameters of the right inferior pulmonary vein (RIPV) predict late electrical reconnection after second-generation cryoballoon ablation?
More inferior RIPV frontal orientation and warmer balloon nadir temperatures independently predict late RIPV electrical reconnection after second-generation cryoballoon ablation.
Odds Ratio: 1.13 (95% CI 1.07–1.19)
p-value: p=<0.001
INTRODUCTION: The right inferior pulmonary vein (RIPV) accounts as the most frequently reconnected vein after pulmonary vein isolation using second-generation cryoballoon ablation (CB-A). Our objective was to assess anatomic predictors of late RIPV reconnection based on preprocedural computed tomography scan. METHODS: Patients with a repeat procedure for atrial tachyarrhythmia recurrence after index CB-A procedure were included. A total of 129 RIPVs were evaluated for ostial diameters, ostial area, and branching pattern. Interior angle between RIPV and horizontal line in the frontal/transversal plane was used to measure the RIPV orientation: RIPV frontal/transversal angle, respectively. In addition, interior angle between RIPV and the line perpendicular on the septal intersection line at the level of the fossa ovalis, estimated as trans-septal (TS) puncture site, was measured in the frontal/transversal view: RIPV-TS frontal/transversal angle, respectively. RESULTS: Late vein reconnection was present in 36/129 RIPVs (28%). Warmer balloon nadir temperature (P = .01), more inferior (P < .001) and posterior (P < .01) RIPV orientation (ie, more positive RIPV frontal and RIPV transversal angle, respectively), and sharper RIPV-TS frontal angle (P < .001) were associated with late RIPV reconnection on univariate analysis. Independent variables after multivariate analysis were nadir temperature (odds ratio OR, 1.12; 95% confidence interval CI, 1.03-1.23; P = .013) and RIPV frontal angle (OR, 1.13, CI, 1.07-1.19; P < .001). CONCLUSION: Frontal RIPV orientation could significantly predict late RIPV electrical reconnection after CB-A. Therefore, preprocedural anatomic assessment of the RIPV might be useful to plan the correct ablation strategy.
Terasawa et al. (Thu,) conducted a observational in Atrial fibrillation (n=129). Frontal right inferior pulmonary vein (RIPV) orientation was evaluated on Late RIPV reconnection (OR 1.13, 95% CI 1.07-1.19, p=<0.001). Frontal right inferior pulmonary vein orientation (OR 1.13) and warmer balloon nadir temperature independently predicted late electrical reconnection after second-generation cryoballoon ablation.