11. The influence of pulmonary vein anatomy on outcomes after ablation of paroxysmal atrial fibrillation

Authors

  • A. Baimbetov Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan https://orcid.org/0000-0002-9971-1309
  • A. Jukenova Fundamental MedicineDepartment, Al-Farabi Kazakh National University, Almaty, Kazakhstan https://orcid.org/0000-0003-4553-4287
  • A. Ualiyeva Epidemiology, Biostatistics and Evidence Based Medicine Department, Al-Farabi Kazakh National University, Almaty, Kazakhstan https://orcid.org/0000-0002-4776-1988
  • K. Bizhanov Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan https://orcid.org/0000-0002-6668-7373
  • A. Sapunov Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan https://orcid.org/0000-0002-7125-8178
  • N. Bigeldiyev Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan https://orcid.org/0000-0003-3988-6569
  • K. Yakupova Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan https://orcid.org/0000-0002-2726-7296
  • N. Okhabekov Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan
  • Zh. Meirambay Interventional Cardiology and Arrhythmology Department, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan

DOI:

https://doi.org/10.35805/BSK2024III011

Downloads

Abstract

Background. Pulmonary vein isolation is the cornerstone of catheter-based treatment for atrial fibrillation. Cryoballoon ablation offers an effective and reproducible method for pulmonary vein isolation, yet recurrence of arrhythmias remains a challenge. Despite advances in catheter technologies, the role of altered pulmonary vein anatomy as a factor for atrial fibrillation recurrence is poorly studied. Materials and

Methods. This prospective study included 465 patients with paroxysmal atrial fibrillation who underwent cryoballoon ablation. Pulmonary vein and left atrial anatomy were evaluated using multislice computed tomography. Patients were followed for 24–48 months to assess atrial fibrillation recurrence and anatomical risk factors. Cox proportional hazard modeling and Kaplan-Meier analysis were used to evaluate predictors of arrhythmia recurrence.

Results. Complete Pulmonary vein isolation was achieved in all patients. During follow-up, 38% of patients experienced atrial fibrillation recurrence. Patients with altered pulmonary vein anatomy, particularly a left common pulmonary vein and additional pulmonary veins, showed a higher rate of recurrence. Cox regression analysis identified left atrial volume index >50 mL/m² and pathological pulmonary vein anatomy as independent risk factors for atrial fibrillation recurrence.

Conclusion. Altered pulmonary vein anatomy is a significant risk factor for atrial fibrillation recurrence following cryoballoon ablation. Comprehensive imaging of the left atrial and pulmonary vein using multislice computed tomography can improve patient selection, reducing the recurrence risk and improving long-term outcomes.

Keywords

Atrial fibrillation, cryoballoon ablation, pulmonary vein anatomy, recurrence, pulmonary vein isolation, multislice computed tomography

References

  1. Kuck KH, Furnkranz A, Chun KR, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxys-mal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J. Oct 7 2016;37(38):2858-2865. doi:10.1093/eurheartj/ehw285
  2. Aryana A, Singh SM, Mugnai G, et al. Pulmonary vein reconnection follow-ing catheter ablation of atrial fibril-lation using the second-generation cryoballoon versus open-irrigated radiofrequency: results of a multi-center analysis. J Interv Card Elec-trophysiol. Dec 2016;47(3):341-348. doi:10.1007/s10840-016-0172-z
  3. Chen X, Xia Y, Lin Y, et al. Cryob-alloon Ablation for Treatment of Atrial Fibrillation in a Chinese Pop-ulation: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure. Front Cardiovasc Med. 2022;9:836392. doi:10.3389/fcvm.2022.836392
  4. Tilz RR, Meyer-Saraei R, Eitel C, et al. Novel Cryoballoon Ablation System for Single Shot Pulmonary Vein Iso-lation- The Prospective ICE-AGE-X Study. Circ J. Jul 21 2021;85(8):1296-1304. doi:10.1253/circj.CJ-21-0094
  5. Baimbetov AK, Bizhanov KA, Jukeno-va AM, Aubakirova AT, Ualiyeva AY, Sagatov IY. Comparative Effective-ness and Safety of Cryoablation Versus Radiofrequency Ablation Treatments for Persistent Atrial Fibrillation. Am J Cardiol. Dec 1 2022;184:22-30. doi:10.1016/j.amj-card.2022.08.031
  6. Su WW, Reddy VY, Bhasin K, et al. Cryoballoon ablation of pulmonary veins for persistent atrial fibrilla-tion: Results from the multicenter STOP Persistent AF trial. Heart Rhythm. Nov 2020;17(11):1841-1847. doi:10.1016/j.hrthm.2020.06.0207.duFaydeLavallazJ,ClercO,PudenzC,IlligensB,KuhneM.Sex-specificefficacyandsafetyofcryoballoonver-susradiofrequencyablationforatrialfibrillation:Asystematicreviewandmeta-analysis.JCardiovascElectro-physiol.Oct2019;30(10):1819-1829.doi:10.1111/jce.14071
  7. Yap SC, Anic A, Breskovic T, et al. Comparison of procedural efficacy and biophysical parameters between two competing cryoballoon technol-ogies for pulmonary vein isolation: Insights from an initial multicenter experience. J Cardiovasc Electro-physiol. Mar 2021;32(3):580-587. doi:10.1111/jce.14915
  8. Baimbetov AK, Bizhanov KA, Ab-zaliyev KB, Bairamov BA, Yakupova IA. Prediction of arrhythmia recur-rence after atrial fibrillation abla-tion in patients with normal anatomy of the left atrium. Int J Clin Pract. Jun 2021;75(6):e14083. doi:10.1111/ijcp.14083
  9. Skowerski M, Wozniak-Skowerska I, Hoffmann A, et al. Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation. BMC Cardiovasc Disord. Jul 13 2018;18(1):146. doi:10.1186/s12872-018-0884-3
  10. Chen YH, Lu ZY, Xiang Y, et al. Cryoablation vs. radiofrequency ab-lation for treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis. Europace. May 1 2017;19(5):784-794. doi:10.1093/eu-ropace/euw330
  11. Aryana A, Baker JH, Espinosa Gin-ic MA, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is su-perior to pulmonary vein isolation alone in patients with persistent U.A.: Statistical analysis, methodology. B.K., O.N.: Data curation. S.A.: Supervi-sion. B.N.: Investigation. Y.A.: Concep-tualization. M.Zh.: Vizualization. All au-thors approved the final version of the manuscript
  12. Wei HQ, Guo XG, Zhou GB, et al. Pro-cedural findings and clinical outcome of second-generation cryoballoon ablation in patients with variant pul-monary vein anatomy. J Cardiovasc Electrophysiol. Jan 2019;30(1):32-38. doi:10.1111/jce.13768
  13. Nakashima T, Kawasaki M, Toyoshi H, et al. Impact of the pulmonary vein orifice area assessed using in-tracardiac echocardiography on the outcome of radiofrequency cath-eter ablation for atrial fibrillation. J Interv Card Electrophysiol. Mar 2018;51(2):133-142. doi:10.1007/s10840-018-0324-4
  14. Anselmino M, Blandino A, Beninati S, et al. Morphologic analysis of left atri-al anatomy by magnetic resonance angiography in patients with atrial fibrillation: a large single center ex-perience. J Cardiovasc Electrophysi-ol. Jan 2011;22(1):1-7. doi:10.1111/j.1540-8167.2010.01853.x
  15. McLellan AJ, Ling LH, Ruggiero D, et al. Pulmonary vein isolation: the impact of pulmonary venous anato-my on long-term outcome of cath-eter ablation for paroxysmal atri-al fibrillation. Heart Rhythm. Apr 2014;11(4):549-56. doi:10.1016/j.hrthm.2013.12.025
  16. Baimbetov A, Bizhanov K, Yakupova I, et al. Efficacy and Safety Results of Different Ablation Technologies for Persistent Atrial Fibrillation Treat-ment. Heart Surg Forum. Aug 21 2022;25(4):E594-E600. doi:10.1532/hsf.4853
  17. R A, Rj H, Wy L, et al. Long Term Outcome and Pulmonary Vein Re-connection of Patients Undergoing Cryoablation and/or Radiofrequency Ablation: Results from The Cryo Ver-sus RF Trial. J Atr Fibrillation. Oct-Nov 2018;11(3):2072. doi:10.4022/jafib.2072
  18. Das M, Wynn GJ, Saeed Y, et al. Pul-monary Vein Re-Isolation as a Rou-tine Strategy Regardless of Symp-toms: The PRESSURE Randomized Controlled Trial. JACC Clin Elec-trophysiol. Jun 2017;3(6):602-611. doi:10.1016/j.jacep.2017.01.016
  19. Andrade JG, Khairy P, Macle L, et al. Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter Sustained Treat-ment of Paroxysmal Atrial Fibrilla-tion (STOP AF) Trial. Circ Arrhythm Electrophysiol. Feb 2014;7(1):69-75. doi:10.1161/CIRCEP.113.000586
  20. Heeger CH, Tscholl V, Wissner E, et al. Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in pa-tients with a left common pulmo-nary vein: A multicenter study. Heart Rhythm. Aug 2017;14(8):1111-1118. doi:10.1016/j.hrthm.2017.05.003
  21. Bose A, Chevli PA, Berberian G, et al. Presence of a left common pulmo-nary vein and pulmonary vein ana-tomical characteristics as predictors of outcome following cryoballoon ablation for paroxysmal atrial fibril-lation. J Interv Card Electrophysiol. Nov 2021;62(2):409-417. doi:10.1007/s10840-020-00916-6
  22. Heeger CH, Sohns C, Pott A, et al. Phrenic Nerve Injury During Cryob-alloon-Based Pulmonary Vein Iso-lation: Results of the Worldwide YETI Registry. Circ Arrhythm Elec-trophysiol. Jan 2022;15(1):e010516. doi:10.1161/CIRCEP.121.010516
  23. Chun KRJ, Perrotta L, Bordignon S, et al. Complications in Catheter Ab-lation of Atrial Fibrillation in 3,000 Consecutive Procedures: Balloon Versus Radiofrequency Current Ab-lation. JACC Clin Electrophysiol. Feb 2017;3(2):154-161. doi:10.1016/j.ja-cep.2016.07.002

Published

2024-09-30

Issue

No. 3 (2024)

Section

Статьи