Key result
Cardiac CT-based anatomic factors independently predicted late pulmonary vein reconnection, including ovality index for the left superior vein (OR 1.61; 95% CI 1.07-2.41; P=0.022).
Why the study?
Anatomic indicators of late pulmonary vein reconnection post-CB2 ablation had not been studied on an individual PV level or weighed against clinical and procedural factors.
Do cardiac CT-based anatomic factors predict late pulmonary vein reconnection in patients with arrhythmia recurrence after cryoballoon ablation?
Observational (n=125)
Do cardiac CT-based anatomic factors predict late pulmonary vein reconnection in patients with arrhythmia recurrence after cryoballoon ablation?
Cardiac CT-based evaluation of anatomic pulmonary vein characteristics provides higher predictive value than clinical and procedural variables for identifying late pulmonary vein reconnection after cryoballoon ablation.
CT-derived PV ovality may aid LPVR risk stratification after cryoballoon ablation; leaves open whether routine use improves outcomes.
AIMS: To identify predictors of individual late pulmonary vein (PV) reconnection after second-generation cryoballoon (CB2) ablation. Anatomic indicators of late pulmonary vein reconnection (LPVR) post-CB2 ablation have not yet been studied on an individual PV level, nor weighed against clinical and procedural factors. METHODS AND RESULTS: Clinical, procedural, and PV anatomic data from 125 patients with a repeat procedure for arrhythmia recurrence after index CB2 ablation were analyzed. Preprocedural computed tomography (CT) evaluated 486 PVs for measurement of size; shape (ovality index); carina width; and orientation angle in frontal (superior/inferior) and transversal (anterior/posterior) plane (with horizontal line 0° as reference and upper/lower half circle as positive/negative value, respectively). Durable isolation in all PVs was demonstrated in 50/125 (40%) patients. Late reconnection rates at the different PVs were as follows: 16% left superior (LS), 12% left inferior (LI), 17% right superior (RS), and 31% right inferior (RI) PV. Multivariable analysis performed per vein showed following independent determinants predicting LPVR: ovality index [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.07-2.41, P = 0.022] and carina width (OR 0.75, CI 0.59-0.96, P = 0.024) for LSPV; carina width (OR 0.71, CI 0.53-0.95, P = 0.020) for LIPV; frontal angle (OR 0.91, CI 0.87-0.95, P < 0.001) for RIPV; and transversal angle (OR 1.15, CI 1.03-1.31, P = 0.032) for RSPV. CONCLUSION: Cardiac CT-based evaluation of anatomic PV characteristics presented higher predictive value compared to clinical and procedural variables for individual LPVR after CB2 ablation. Pre-procedural identification of unfavourable PV anatomy might be important to tailor the ablation approach.
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Terasawa et al. (2022) conducted an observational in Arrhythmia recurrence after cryoballoon ablation (n=125). Cardiac CT-based anatomic factors was evaluated on Late pulmonary vein reconnection (LPVR) (OR 1.61, 95% CI 1.07-2.41, p=0.022). Cardiac CT-based anatomic factors independently predicted late pulmonary vein reconnection, including ovality index for the left superior vein (OR 1.61; 95% CI 1.07-2.41; P=0.022).
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