The left common pulmonary vein trunk anatomy impact on the catheter ablation atrial fibrillation treatment outcomes

Anatomical variations of pulmonary veins, especially the presence of left common pulmonary venous trunk (LCPVT), play an important role not only in the pathogenesis of atrial fibrillation (AF), but also in the efficacy of catheter treatment, which determines the relevance of their influence on the ablation results. Objective. To determine whether the presence of left common pulmonary venous trunk is an independent anatomical marker of increased risk of atrial fibrillation development, and to evaluate its influence on clinical results of catheter ablation in atrial fibrillation, including the comparative efficacy of catheter and balloon technologies in this category of patients. Materials and methods. We analyzed publications from international and Russian databases (PubMed, Scopus, Web of Science, RSCI) for the 2000—2024 period in order to prepare this review. The analysis was focused on the recurrence rate of atrial fibrillation, efficacy and safety of various LCPVT isolation methods. Results. The presence of LCPVT is associated with a statistically significant decrease in the efficacy of cryoballoon ablation: the rate of AF recurrences reaches 54—56% (12—26% in standard anatomy, p<0.05). Multifactorial analysis allowed to identify the LCPVT as an independent predictor of arrhythmia relapse. At the same time, the use of optimized protocols with sequential cryoapplications allows to achieve 95.9% of successful acute isolation and increase long-term efficacy to 69.4—74.0% at the median of follow-up equal 12—17 months. Conclusion. The presence of the left common pulmonary venous trunk is an important anatomical factor affecting the efficacy of ablation in atrial fibrillation. The application of new cryoballoon ablation techniques, high-density mapping and individual strategy selection allows to increase the success of intervention and reduce the risk of recurrence.