Impact of altered pulmonary vein anatomy on long-term outcomes after cryoablation of paroxysmal atrial fibrillation

Abstract Background Cryoballoon catheter treatment for pulmonary vein (PV) isolation is an effective method for treating paroxysmal atrial fibrillation (AF). Purpose Evaluation of the significance of certain anatomical features of pulmonary veins for predicting the development of arrhythmia recurrence after pulmonary vein cryoballoon ablation (PV CBA) in paroxysmal AF. Materials and Methods 465 consecutive patients (61% were male) with paroxysmal AF (57±11 years) were included and analyzed. All underwent CPVA between 2018 and 2022. PV and left atrial (LA) anatomy were evaluated in all patients using multi-slice computed tomography (MSCT) before the CPVA procedure. After the ablation procedure, all patients were followed up for 24-56 months to assess the impact of pathologic abnormalities in PV anatomy on recurrences in the long-term follow-up period. Results Complete PV isolation was achieved in all patients. LA and PV anatomy was normal in 298 patients (64%). Pathologic change of PV anatomy was present in 167 patients. (36%). During 24-56 months of follow-up, AF recurrence was registered in 178 patients (38%). Patients with recurrent AF had mainly enlarged right (RSPV) and left superior PVs (LSPV) (p<0.001). The presence of left common PVs (n=126, Log-rank p<0.001), as well as the presence of additional right pulmonary veins (n=67, Log-rank p<0.001), was associated with early development of sustained arrhythmia recurrences, compared to patients with typical PV characteristics. Conclusion Altered PV anatomy is a risk factor for arrhythmia recurrence after PV CBA. Mandatory visualization of the LA and PV with MSCT improves patient selection for effective catheter-based treatment of atrial fibrillation.