What is the clinical evidence from this study?

Study design: Cohort. Population: Drug refractory paroxysmal or persistent atrial fibrillation (n=118). Intervention: Normal pulmonary veins anatomy vs. Atypical anatomy with common left pulmonary vein (CLPV). Primary outcome: AF-free survival (p=0.02).

What does this research mean for the field?

Normal pulmonary vein anatomy is associated with significantly better atrial fibrillation-free survival compared to atypical anatomy with a common left pulmonary vein following cryoablation, particularly in patients with paroxysmal atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 21, 2011

Normal Pulmonary Veins Anatomy is Associated with Better AF‐Free Survival after Cryoablation as Compared to Atypical Anatomy with Common Left Pulmonary Vein

Key Result

Normal pulmonary vein anatomy was associated with significantly better AF-free survival compared to atypical anatomy with a common left pulmonary vein after cryoablation (67% vs 50%, P=0.02).

Study Design

Type

Cohort (n=118)

Structured PICO

Does normal pulmonary vein anatomy improve AF-free survival compared to common left pulmonary vein anatomy in patients undergoing pulmonary vein cryoablation?

Population

118 consecutive patients with drug refractory paroxysmal (72%) or persistent (28%) atrial fibrillation, mean age 56 ± 10 years, 77% male.

Intervention

Pulmonary vein cryoablation in patients with normal pulmonary vein anatomy determined by CT

Comparator

Pulmonary vein cryoablation in patients with atypical pulmonary vein anatomy (common left pulmonary vein) determined by CT

Outcome

Atrial fibrillation-free survival (recurrence defined as AF lasting at least 30 seconds) at 13 months follow-up

Normal pulmonary vein anatomy is associated with better AF-free survival after cryoablation compared to having a common left pulmonary vein, particularly in patients with paroxysmal AF.

Main Result

Absolute Event Rate: 67% vs 50%

p-value: p=0.02

Abstract

BACKGROUND: Pulmonary vein cryoablation (PVC) is a new approach in the treatment of recurrent atrial fibrillation (AF). Computed tomography (CT) can be used to evaluate the left atrium anatomy and PVs dimensions to facilitate the procedure. In radiofrequency procedures, some anatomic variants such as common left (CLPV) or right (CRPV) PV were reported as factors associated with technical procedure difficulties and potential long-term complications. We hypothesized that the absence of CLPV as determined by CT would predict better AF-free survival after PVC. METHODS AND RESULTS: We included 118 consecutive patients (mean age 56 ± 10 years; 77% males) with drug refractory paroxysmal (72%)/persistent (28%) AF, with more than 6 months follow-up, who underwent PVC. On CT scanning images performed within 1 month prior to ablation, we evaluated PV anatomic patterns: presence of CLPV or CRPV. Each patient was evaluated by 24-hour Holter monitoring within 1 and 3 months and all patients were periodically evaluated at 1, 3, and 6 months, and every 6 months thereafter. Patients were asked to record their 12-lead electrocardiogram whenever they experienced symptoms suggestive of AF. Recurrence was defined as AF that lasted at least 30 seconds. CLPV was present in 30 (25%) patients and no patients with CRPV were identified. At the end of the 13 months follow-up, patients with normal PVs had significantly better AF-free survival compared to patients with CLPV (67% vs 50%, P = 0.02). The difference was present in patients with paroxysmal AF (P = 0.008) but not in patients with persistent AF (P = 0.92). CONCLUSION: In patients undergoing cryoballoon PV isolation for AF, the presence of normal PVs pattern is associated with better AF-free survival as compared to atypical PV anatomy with CLPV, particularly in patients with paroxysmal AF.

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