Impact of pulmonary vein variant anatomy and cross-sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single-shot guided pulmonary vein isolation

Denise Guckel; Philipp Lucas; Khuraman Isgandarova; Mustapha El Hamriti; Leonard Bergau; Thomas Fink; Vanessa Sciacca; Martin Braun; Moneeb Khalaph; Guram Imnadze; Georg Nölker; Philipp Sommer; Christian Sohns

doi:10.1007/s10840-022-01279-w

Impact of pulmonary vein variant anatomy and cross-sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single-shot guided pulmonary vein isolation

J Interv Card Electrophysiol. 2022 Oct;65(1):251-260. doi: 10.1007/s10840-022-01279-w. Epub 2022 Jun 28.

Authors

Affiliations

¹ Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
² Clinic for Internal Medicine II/Cardiology, Christliches Klinikum Unna Mitte, Unna, Germany.
³ Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany. csohns@hdz-nrw.de.

Abstract

Background: Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). This study aimed to evaluate ablation efficacy and freedom from arrhythmia recurrence using the novel POLARx compared to the Arctic Front Advance Pro (AFA) CB system including the analysis of individual PV characteristics.

Methods: A total of 687 patients underwent CB-guided ablation for AF. Arrhythmia recurrence was defined as an ECG documented episode of any AF/atrial tachycardia (AT) > 30 s. Anatomical characteristics were assessed using magnetic resonance imaging (MRI). For each PV, the cross-sectional orifice area (CSOA) was determined. Follow-up examinations were scheduled after 3, 6, and 12 months.

Results: Acute PVI was achieved in all patients. Twelve-month AF-free survival was similar between the groups (POLARx 43/86 (50%) vs. AFA 318/601 (53%), Log-rank (LR) p = 0.346). MRI found a comparable percentage of patients with normal PV anatomy (POLARx 71/86 (83%) vs. AFA 530/601 (85%), p = 0.162). Patients with variant PV characteristics presented with a significantly impaired 12-month AF-free survival (normal PVs 326/585 (56%) vs. variant PVs 27/102 (27%), LR p < 0.001) independent of the applied CB ablation system. PAF patients with AF recurrence presented with significantly larger CSOA of the left-sided PVs and the right superior PVs (LSPV: p < 0.001; LIPV: p < 0.001; RSPV: p < 0.001). In PERS AF, no association between CSOA and ablation outcome was observed. Multivariate analyses identified PERS AF (hazard ratio (HR) 2.504, confidence interval (CI), 1.900-3.299, p < 0.001) and variant PV anatomy (HR 2.124, CI 1.608-2.805, p < 0.001) as independent predictors for AF recurrence.

Conclusions: Both CB ablation systems are associated with comparable 12-month AF-free survival rates. Variant PV anatomy seems to be predictive for AF recurrence. An association between CSOA and the outcome after CB-guided PVI was demonstrated for PAF.

Keywords: AF recurrence; Atrial fibrillation; Catheter ablation; Cryoballoon; Magnetic resonance imaging; Single-shot ablation devices.

MeSH terms

Atrial Fibrillation* / diagnostic imaging
Atrial Fibrillation* / surgery
Catheter Ablation* / methods
Cross-Sectional Studies
Cryosurgery* / methods
Freedom
Humans
Pulmonary Veins* / diagnostic imaging
Pulmonary Veins* / surgery
Recurrence
Treatment Outcome