Impact of Pulmonary Vein Ostium Morphology on Outcomes of Second‐Generation Cryoablation for Paroxysmal Atrial Fibrillation: Procedural Characteristics and Long‐Term Recurrence

Background Cryoballoon ablation (CbA) for pulmonary vein isolation (PVI) is increasingly used in the treatment of paroxysmal atrial fibrillation (PAF). We aimed to assess the relationship between pulmonary vein ostium (PVO) morphology and procedural outcomes after CbA for PAF. Methods A total of 463 patients with PAF were enrolled. PVO morphology was evaluated using preprocedural computed tomography (CT). Intraoperative cryoablation parameters and adverse events were recorded. Patients were followed up for at least 1 year. Results The superior PVs exhibited the longest long‐axis diameter at PVO (left, 21.85 ± 3.22 mm; right, 21.55 ± 3.71 mm, all p < 0.05), while the right superior PVs had the largest short‐axis diameter (18.46 ± 3.56 mm, all p < 0.05). The left superior PVO showed the greatest ellipticity (difference between long‐axis and short‐axis diameters: 6.60 ± 3.35 mm, all p < 0.05), whereas the right superior PVO had the largest mean diameter (20.00 ± 3.42 mm, all p < 0.05). Left‐sided PVOs demonstrated the highest ellipticity. The size of the left superior PVO was negatively correlated with the nadir freezing temperature and positively correlated with rewarming time (both p < 0.05). The long‐axis diameter of PVO was positively associated with the additional radiofrequency ablation ( p < 0.05). Multivariate analysis identified left superior PVO morphology as an independent predictor of late recurrence ( β = 2.703, p = 0.010). Conclusions Large PVO dimensions, particularly in the left superior PV, are associated with intraoperative difficulty during second‐generation CbA for PAF. Additionally, left superior PVO ellipticity predicts late recurrence. Preprocedural PV CT imaging may be valuable for a quick clinical predict for PAF.