Atrial Fibrillation Ablation Using Cryoballoon Versus Robotic Magnetic Navigation in Patients With Pulmonary Vein Variant

Objective The outcomes of ablation for atrial fibrillation (AF) in patients with pulmonary vein (PV) variants remain controversial. The aim of this study was to compare procedure data and outcomes in paroxysmal AF patients with PV variant for cryoballoon (CRYO) ablation and robotic magnetic navigation (RMN) ablation. Methods A retrospective analysis assigned 256 patients underwent CRYO ablation and 254 patients underwent RMN ablation. They were divided into PV variant patients who underwent CRYO ablation (CRYO variant group, 58 cases); PV normal patients who underwent CRYO ablation (CRYO normal group, 198 cases); PV variant patients who underwent RMN ablation (RMN variant group, 49 cases); and the PV normal patients who underwent RMN ablation (RMN normal group, 205 cases). Results Compared with the RMN variant group, the procedure time (91.7 ± 14.8 min vs. 150.0 ± 16.4 min, p < 0.001) was significantly decreased in the CRYO variant group, while the X‐ray time (20.9 ± 6.3 min vs. 7.4 ± 3.1 min, p < 0.001) and dose (574.0 ± 302.5 mGy vs. 206.5 ± 102.2 mGy, p < 0.001) were significantly increased. The rates of maintaining sinus rhythm during 1 year of follow‐up were similar in both groups (47/58 vs. 42/49, p = 0.497). Compared with the CRYO variant group, the procedure time, X‐ray time, and dose were decreased in the CRYO normal group. However, there was no significant difference in procedure time, X‐ray time, and dose between the RMN normal group and the RMN variant group. No matter which method was used, there was no significant difference in the 1‐year follow‐up recurrence rate between PV variant and PV normal patients. COX regression analysis showed that the ablation method is not a predictive factor for recurrence in PV variant ablation. Conclusions CRYO and RMN have similar outcomes during a 1‐year follow‐up for patients with PV variants. Unlike RMN ablation, PV variants increase the procedure difficulty of CRYO ablation, manifested by increased procedure time, X‐ray time, and dose.