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Pulmonary vein size is associated with reconnection following cryoballoon ablation of atrial fibrillation

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Abstract

Background

The second-generation cryoballoon (CB) has proven to be a highly effective ablative strategy in patients with symptomatic atrial fibrillation (AF). This study sought to investigate the anatomical characteristics of pulmonary veins (PVs) and the relationship between their size, ovality, and late reconnections in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias.

Methods and results

A total of 152 consecutive patients (98 males, 64.5%; mean age 64.9 ± 9.6 years) underwent a repeat ablation for recurrent atrial tachyarrhythmias after a median time of 6.5 months [IQR 11] from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 593 PVs, 134 (22.6%) showed a late PV reconnection in 95 patients (0.88 per patient), at the time of repeat ablation procedure. There was a significant difference in ovality between left- and right-sided PVs (p < 0.001). Greater diameters of left superior PV, left inferior PV, and right inferior PV ostia (both maximum and minimum) and higher index ovality were significantly associated with late PV reconnection.

Conclusions

The rate of late PV reconnection after CB ablation was low (0.88 PVs/patient). Left-sided PVs were more oval than septal PVs. Larger PV dimensions and higher ovality index were significantly associated with reconnections in all PVs except for RSPV.

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Author notes

  1. Giacomo Mugnai and Federico Cecchini equally contributed as first co-authors.

  2. Carlo De Asmundis and Gian-Battista Chierchia equally contributed as senior authors.

Authors and Affiliations

  1. Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium

    Giacomo Mugnai, Federico Cecchini, Erwin Stroker, Gaetano Paparella, Saverio Iacopino, Juan Sieira, Gezim Bala, Ingrid Overeinder, Alexandre Almorad, Anais Gauthey, Antonio Sorgente, Carlo de Asmundis & Gian-Battista Chierchia

  2. Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy

    Giacomo Mugnai, Luca Tomasi, Bruna Bolzan & Flavio Luciano Ribichini

  3. Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium

    Federico Cecchini & Yves De Greef

Authors
  1. Giacomo Mugnai
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  16. Carlo de Asmundis
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Corresponding author

Correspondence to Giacomo Mugnai.

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Ethics approval

The retrospective registry has been approved by the Institutional Ethics Committee of our institution.

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None.

Conflict of interest

G.B.C. reports speaker fees for Medtronic, Biotronik, Biosense Webster, and Abbott; teaching honoraria from Medtronic and Biotronik; and proctoring honoraria from Medtronic; C.d.A. reports speaker fees for Medtronic, Biotronik, Biosense Webster, Abbott, and Boston Scientific; teaching honoraria from Medtronic, Biotronik, Abbott, and Boston Scientific; and proctoring honoraria from Medtronic, Abbott, and Biotronik.

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Mugnai, G., Cecchini, F., Stroker, E. et al. Pulmonary vein size is associated with reconnection following cryoballoon ablation of atrial fibrillation. J Interv Card Electrophysiol 65, 717–724 (2022). https://doi.org/10.1007/s10840-022-01330-w

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