Key result
Variant pulmonary vein anatomy linked to ~150% greater late AF recurrence after cryoballoon ablation.
Why the study?
Cryoballoon-guided PVI is established for AF, but the role of individual anatomical characteristics in predicting long-term freedom from arrhythmia recurrence needed assessment.
Does variant pulmonary vein anatomy predict arrhythmia recurrence after cryoballoon-guided pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
Observational (n=353)
No
Does variant pulmonary vein anatomy predict arrhythmia recurrence after cryoballoon-guided pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
Absolute Event Rate: 45% vs 18%
p-value: p=<0.001
Variant pulmonary vein anatomy and enlarged cross-sectional areas of specific pulmonary veins are strong predictors of atrial fibrillation recurrence after cryoballoon-guided pulmonary vein isolation.
May warrant enhanced surveillance after cryoballoon PVI in variant-PV patients; hypothesis-generating for anatomy-tailored strategies in prospective trials.
BACKGROUND: Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). This observational study aimed to assess the role of individual anatomical characteristics to predict long-term freedom from arrhythmia recurrence after CB-guided PVI for paroxysmal AF (PAF). METHODS: Three hundred fifty three consecutive patients (58 ± 11 years, 56% males), undergoing PVI between 2012 and 2018 were analysed. Individual pulmonary vein (PV) anatomy was assessed using preprocedural cardiac magnetic resonance imaging (MRI). For each PV, the cross-sectional area (CSA) was calculated. The impact of PV characteristics and CSA on long-term AF-free survival was evaluated. RESULTS: Acute PVI was achieved in all patients. Two hundred twenty-three patients (63%) had a normal PV anatomy (2 left- and 2 right-sided PV). Variant PV anatomy was present in 130 patients (37%). During the observation period of 48 months, AF-recurrence was documented in 167 patients (47 %). Patients with AF-recurrence presented with significantly enlarged right-sided PVs and left superior PVs (LSPVs) (p < 0.001). The presence of left common PVs (LCPVs) (n = 75, Log-rank p < 0.001) as well as right variant PVs (n = 35, Log rank p < 0.001) was associated with a significantly impaired long-term AF-free survival rate as compared to patients with normal PV characteristics. CONCLUSION: Variant PV anatomy is a good predictor for AF-recurrence. A correlation between an enlarged CSA of right-sided PVs as well as LSPVs and AF-recurrence was documented.
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Isgandarova et al. (2023) conducted an observational in Paroxysmal atrial fibrillation (n=353). Variant pulmonary vein anatomy vs. Regular pulmonary vein anatomy was evaluated on Late atrial fibrillation recurrence (p=<0.001). Variant pulmonary vein anatomy was associated with a significantly higher rate of late atrial fibrillation recurrence (45%) compared to normal anatomy (18%) following cryoballoon ablation.
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