Alex J A McLellan1, Liang-han Ling1, Diego Ruggiero2, Michael C G Wong3, Tomos E Walters3, Ashley Nisbet3, Anoop K Shetty3, Sonia Azzopardi2, Andrew J Taylor2, Joseph B Morton4, Jonathan M Kalman4, Peter M Kistler5. 1. Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia. 2. Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia. 3. Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia. 4. Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne Private Hospital, Parkville, Victoria, Australia. 5. Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne Private Hospital, Parkville, Victoria, Australia. Electronic address: peter.kistler@bakeridi.edu.au.
Abstract
BACKGROUND: Circumferential pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF); however, PV reconnection remains problematic. OBJECTIVE: To assess the impact of PV anatomy on outcome after AF ablation. METHODS: One hundred two patients with paroxysmal AF underwent cardiac magnetic resonance (60%) or computed tomography (40%) before AF ablation. PV anatomy was classified according to the presence of common PVs, accessory PVs, PV branching pattern, and the dimensions of the PV ostia, intervenous ridges (IVRs), and the left PV-left atrial appendage ridge. RESULTS: Four discrete PVs were present in 48(47%) of the patients: a left common PV in 38(37%), a right common PV in 2(2%), an accessory right PV in 20(20%), and left PV in 4(4%). At a mean follow-up of 12 ± 4 months, 75 of 102 (74%) patients were free of recurrent AF. A LCPV was associated with an increase in freedom from AF (87% vs 66% for 4 PV anatomy; P = .03). Greater left IVR length (16.9 ± 3.5 mm vs 14.0 ± 3.0 mm; P ≤ .001) and width (1.4 ± 0.6 mm vs 1.1 ± 0.6 mm; P = .02) were associated with increased AF recurrence. After multivariate analysis, abnormal anatomy (LCPV or accessory PV) and left IVR length were found to be the only independent predictors of freedom from AF. CONCLUSIONS: Four discrete PVs are present in the minority of patients with paroxysmal AF undergoing PV isolation. The presence of a LCPV is associated with an increased freedom from AF after catheter ablation. PV anatomy may in part explain the variable outcome to electrical isolation in patients with paroxysmal AF.
BACKGROUND: Circumferential pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF); however, PV reconnection remains problematic. OBJECTIVE: To assess the impact of PV anatomy on outcome after AF ablation. METHODS: One hundred two patients with paroxysmal AF underwent cardiac magnetic resonance (60%) or computed tomography (40%) before AF ablation. PV anatomy was classified according to the presence of common PVs, accessory PVs, PV branching pattern, and the dimensions of the PV ostia, intervenous ridges (IVRs), and the left PV-left atrial appendage ridge. RESULTS: Four discrete PVs were present in 48(47%) of the patients: a left common PV in 38(37%), a right common PV in 2(2%), an accessory right PV in 20(20%), and left PV in 4(4%). At a mean follow-up of 12 ± 4 months, 75 of 102 (74%) patients were free of recurrent AF. A LCPV was associated with an increase in freedom from AF (87% vs 66% for 4 PV anatomy; P = .03). Greater left IVR length (16.9 ± 3.5 mm vs 14.0 ± 3.0 mm; P ≤ .001) and width (1.4 ± 0.6 mm vs 1.1 ± 0.6 mm; P = .02) were associated with increased AF recurrence. After multivariate analysis, abnormal anatomy (LCPV or accessory PV) and left IVR length were found to be the only independent predictors of freedom from AF. CONCLUSIONS: Four discrete PVs are present in the minority of patients with paroxysmal AF undergoing PV isolation. The presence of a LCPV is associated with an increased freedom from AF after catheter ablation. PV anatomy may in part explain the variable outcome to electrical isolation in patients with paroxysmal AF.
Authors: Aditi S Vaishnav; Edris Alderwish; Kristie M Coleman; Moussa Saleh; Parth Makker; Kabir Bhasin; Neil E Bernstein; Nicholas T Skipitaris; Stavros E Mountantonakis Journal: J Interv Card Electrophysiol Date: 2020-06-30 Impact factor: 1.900
Authors: Faisal M Merchant; Mathew R Levy; Shahriar Iravanian; Edward C Clermont; Heval M Kelli; Robert L Eisner; Mikhael F El-Chami; Angel R Leon; David B Delurgio Journal: J Interv Card Electrophysiol Date: 2016-01-26 Impact factor: 1.900
Authors: Catherine Gebhard; Nazmi Krasniqi; Barbara E Stähli; Bernd Klaeser; Tobias A Fuchs; Jelena R Ghadri; Laurent Haegeli; Thomas F Lüscher; Philipp A Kaufmann; Firat Duru Journal: Cardiol Res Pract Date: 2014-06-25 Impact factor: 1.866