Pulmonary vein to ganglionated plexi distance predicts cryoballoon ganglionated plexi modification

Background Cryoballoon ablation (CBA) for atrial fibrillation (AF) can cause incidental modification of ganglionated plexi (GP), which may contribute to arrhythmia control; however, the anatomical factors associated with GP modification remain poorly understood. Objectives We investigated the relationship between the distance from the pulmonary vein–left atrial (PV–LA) junction to GP sites and GP modification during CBA using voltage mapping. Methods This retrospective study analyzed 50 patients with paroxysmal AF undergoing CBA. Pre-procedural computed tomography images were integrated into a three-dimensional electroanatomical mapping system to measure pulmonary vein–ganglionated plexus (PV–GP) distances. GP modification was defined as voltage attenuation at GP sites after ablation. Receiver operating characteristic analysis was performed to assess predictive performance. Results GP modification occurred more frequently at sites located closer to the PV–LA junction. Upper GP regions demonstrated higher modification rates than lower regions, and PV–GP distance showed reasonable discrimination for predicting GP modification. Conclusions Anatomical proximity between the PV–LA junction and GP appears to be a key determinant of GP modification during CBA. Quantitative assessment of PV–GP distance may help predict autonomic effects and support optimization of AF ablation strategies.