Paroxysmal Atrial Fibrillation Catheter Ablation Outcome Depends on Pulmonary Veins Anatomy

Abstract

BackgroundPulmonary veins (PV) are often the trigger to atrial fibrillation (AF). Occasionally, left PVs converge on a common trunk (LCT) providing a simpler structure for catheter ablation.ObjectiveTo compare the clinical characteristics and outcomes of ablation in paroxysmal atrial fibrillation (PAF) of patients with or without LCT.MethodsCase-control study of patients undergoing first-ever catheter ablation procedure for drug refractory PAF. The information was taken from patients' records by means of a digital collection instrument, and indexed to an online database (Syscardio(r)). Clinical characteristics and procedures were compared between patients with or without LCT (LCT x n-LCT), adopting a level of statistical significance of 5%. The primary endpoint associated with efficacy was lack of atrial arrhythmia over the follow-up time.ResultsOne hundred and seventy two patients with PAF were included in the study, 30 (17%) LCT and 142 (83%) n-LCT. The clinical characteristics, comorbidities, symptoms scale and risk scores did not differ between the groups. There was AF recurrence in 27% of PAF patients in the n-LCT group and only 10% of patients in the LCT group (OR: 3.4 p: 0.04) after a follow-up of 34 ± 17 months and 26 ± 15 months respectively.ConclusionPatients with a LCT have a significantly lower recurrence rate when compared to patients without this structure. It is mandatory to report the results of AF catheter ablation as a PV anatomical variation function.

A left common pulmonary vein: Anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation

“…Hunter et al analyzed the relationship between PVs anatomy and outcomes of AF ablation in 255 patients (an LCPV in 15% patients) and found that an LCPV was associated with a 12.8% absolute decrease in first procedure success. However, the result was in contrast to more recent studies, which reported that an LCPV was an independent predictor of AF freedom after index ablation . There were also several studies reporting no association between an LCPV and outcomes of initial AF ablation .…”

“…Second, as mentioned above, no united definition of the LCPV exists. In the current study, we applied the definition described by cardiac pathologist Cabrera et al The results should be explained with caution when another definition is applied. Third, force contact catheter technology was seldom applied in our study, which might provide underlying mechanisms of our findings.…”

“…However, the result was in contrast to more recent studies, which reported that an LCPV was an independent predictor of AF freedom after index ablation. 5,12 There were also several studies reporting no association between an LCPV and outcomes of initial AF ablation. [17][18][19] The reason for the discrepancies among these studies was unclear.…”

“…[7][8][9] The association between an LCPV and the outcome of the initial RFCA of AF was also explored by several studies which reported conflicting results. 5,6,[10][11][12] However, to our knowledge, whether or not an LCPV has an influence on the outcome of repeated RFCA for AF has never been discussed and the current study aims to fill in the gap.…”

Recurrencia de la fibrilación auricular posablación de las venas pulmonares. Identificación de factores predictores

“…Sohns y colaboradores valoraron la anatomía de las VP utilizando TC de 64 cortes y observaron que una anatomía atípica, diferente a cuatro venas, cada una con su propio ostium, es un fuerte predictor de recurrencia, siendo la variante tronco común izquierdo la que asocia un riesgo mayor (24) . Contrariamente, Odozynski y colaboradores valoraron de forma retrospectiva la anatomía de las VP de pacientes que recibieron ablación de FA paroxística refractaria a fármacos antiarrítmicos y observaron que la presencia de un tronco común izquierdo se relaciona con menos recurrencia (25) . Huang y colaboradores, en un estudio prospectivo utilizando crioablación, demostraron que las variantes en la anatomía de las VP no son factores predictores de éxito a largo plazo (26) .…”