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

Xu, Bocheng; Xing, Yangbo; Xu, Chao; Peng, Fang; Sun, Yong; Wang, Shengkai; Guo, Hangyuan

doi:10.1111/jce.13876

Cited by 14 publications

(27 citation statements)

References 28 publications

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“…To date, studies evaluating the presence of an LCPV affecting ablation success have shown variable results. 5,6,14,15,22 However, these studies were limited by a small sample size, a mixed population of both paroxysmal and persistent AF, and a majority of them employed the RF ablation technique. On reviewing the existing literature, we identified only one small single-center study which exclusively looked at paroxysmal AF patients undergoing CBA.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, studies evaluating the presence of an LCPV affecting CBA outcomes have shown variable results. 5,14,15 A number of single-center studies have also assessed the role of PV anatomical indices such as eccentricity index (EI), area of vein (PVA) and ovality index (OI) in relation to CBA outcomes. 12,13,16 However, these studies were limited by a small sample size and the inclusion of a mixed population of both paroxysmal and persistent AF patients.…”

Section: Introductionmentioning

confidence: 99%

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Presence of a Left Common Pulmonary Vein and Pulmonary Vein Anatomical Characteristics as Predictors of Outcome Following Cryoballoon Ablation for Paroxysmal Atrial Fibrillation

Bose

Chevli

Berberian

et al. 2020

Preprint

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Introduction: Pulmonary vein (PV) isolation using cryoballoon ablation (CBA) is a common therapy for patients with drug refractory paroxysmal atrial fibrillation (PAF). However, initial CBA is successful in only 70-80% of patients. The role of an atypical left common PV (LCPV) and PV anatomical indices on CBA outcomes remains unclear. Methods and Results: We followed 80 patients (age 60.7 ± 9.7, 31 % women) with PAF undergoing CBA for one-year post-procedure for the development of recurrent atrial arrhythmias (AA). Recurrence was assessed by documented AA on EKG or any form of long-term cardiac rhythm monitoring. The presence of an LCPV and individual PV diameters were evaluated using cardiac CT. Based on the maximum and minimum PV ostial diameters, the eccentricity index (EI), ovality index (OI), and PV ostial area (PVA) were calculated for all the veins. A multivariable cox-proportional hazard model assessed whether the presence of an LCPV or PV anatomic indices (EI, OI and PVA) predicted recurrence of AA following CBA. After one year follow up, 19 (23.7%) participants developed recurrence of AA. On multivariable regression, the presence of an LCPV did not predict the recurrence of AA (p = 0.38). Among the PV anatomical indices, on univariate analysis, only the area of the left inferior PV showed a trend towards predicting recurrence, though this result was not significant on multivariate analysis (p = 0.09). Conclusion: In patients with PAF, neither the presence of an LCPV nor individual PV anatomical indices predicted recurrence of AA following CBA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Presence of a Left Common Pulmonary Vein and Pulmonary Vein Anatomical Characteristics as Predictors of Outcome Following Cryoballoon Ablation for Paroxysmal Atrial Fibrillation

Bose

Chevli

Berberian

et al. 2020

Preprint

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“…However, compared to our study, they included only patients with paroxysmal AF. Another recent study of Xu et al [23] showed that a LCPV was independently associated with better outcomes after repeated RFCA of AF, when compared with typical left-sided PVs. The study also reports that PV reconnection is more frequently identified in cases that present a LCPV anomaly, explaining to some degree the link between this anomaly and the results of repeated ablation.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation

et al. 2019

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Background and Objectives: Prior studies have identified a number of predictors for Atrial fibrillation (AF) ablation success, including comorbidities, the type of AF, and left atrial (LA) size. Ectopic foci in the initiation of paroxysmal AF are frequently found in pulmonary veins. Our aim was to assess how pulmonary vein anatomy influences the recurrence of atrial fibrillation after radiofrequency catheter ablation. Materials and Methods: Eighty patients diagnosed with paroxysmal or persistent AF underwent radiofrequency catheter ablation (RFCA) between November 2016 and December 2017. All of these patients underwent computed tomography before AF ablation. PV anatomy was classified according to the presence of common PVs or accessory PVs. Several clinical and imagistic parameters were recorded. After hospital discharge, all patients were scheduled for check-up in an outpatient clinic at 3, 6, 9, and 12 months after RFCA to detect AF recurrence. Results: A total of 80 consecutive patients, aged 53.8 ± 9.6 years, 54 (67.5%) men and 26 (32.5%) women were enrolled. The majority of patients had paroxysmal AF 53 (66.3%). Regular PV anatomy (2 left PVs, 2 right PVs) was identified in 59 patients (73.7%), a left common trunk (LCT) was detected in 15 patients (18.7%), an accessory right middle pulmonary vein (RMPV) was found in 5 patients (6.25%) and one patient presented both an LCT and an RMPV. The median follow-up duration was 14 (12; 15) months. Sinus rhythm was maintained in 50 (62.5%) patients. Age, gender, antiarrhythmic drugs, and the presence of cardiac comorbidities were not predictive of AF recurrence. The diagnosis of persistent AF before RFCA was more closely associated with an increase in recurrent AF after RFCA than after paroxysmal AF (p = 0.01). Longer procedure times (>265 min) were associated with AF recurrence (p = 0.04). Patients with an LA volume index of over 48.5 (mL/m2) were more likely to present AF recurrence (p = 0.006). Multivariate analysis of recurrence risk showed that only the larger LA volume index and variant PV anatomy were independently associated with AF recurrence. Conclusion: The study demonstrated that an increased volume of the left atrium was the most important predictive factor for the risk of AF recurrence after catheter ablation. Variant anatomy of PV was the only other independent predictive factor associated with a higher rate of AF recurrence.

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“…Според различни проучвания анатомични варианти на белодробния венозен дренаж в ЛП се откриват често и варират в много широки граници -от 19 до 75% [2][3][4][5][6][7][8]. Едновременно възникна и интерес дали вариантната анатомия повлиява по някакъв начин непосредствените и отдалечените резултати от аблацията за ПМ [9][10][11][12][13]. Докладваните резултати са разнопосочни.…”

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“…According to various studies, anatomical variants of pulmonary venous drainage in the LA are often found and vary in a very wide range -from 19 to 75% [2 -8]. At the same time, there was interest in whether variant anatomy in any way aff ects the acute and remote results of ablation for AF [9][10][11][12][13]. The reported results are inconsistent.…”

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confidence: 99%

Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

Динева¹,

Стоянов²,

Партенова³

et al. 2021

Bulgarian Cardiology

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Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial ﬁ brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signiﬁ cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after ﬁ rst pulmonary vein isolation.

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

Cited by 14 publications

References 28 publications

Presence of a Left Common Pulmonary Vein and Pulmonary Vein Anatomical Characteristics as Predictors of Outcome Following Cryoballoon Ablation for Paroxysmal Atrial Fibrillation

Presence of a Left Common Pulmonary Vein and Pulmonary Vein Anatomical Characteristics as Predictors of Outcome Following Cryoballoon Ablation for Paroxysmal Atrial Fibrillation

The Impact of Pulmonary Vein Anatomy on the Outcomes of Catheter Ablation for Atrial Fibrillation

Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

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