Optimal diameter of the pulmonary vein ostium for second‐generation 28‐mm cryoballoon ablation of atrial fibrillation

Abstract

Background Large pulmonary veins (PVs) have the risk of excessive cooling when the cryoballoon is moved into them, whereas smaller PVs may not be isolated because of insufficient balloon‐tissue contact. We previously reported that the effective nadir balloon temperature (NBT) was <− 44°C for predicting early PV reconnections. However, the ideal PV and left atrial (LA) diameters for cooling temperatures during cryoballoon ablation (CBA) are unknown. Methods We measured the PV ostium (PVos) and LA diameters on computed tomography images in 71 atrial fibrillation patients who underwent a 28‐mm CBA. We defined −60°C ≤ NBT <− 44°C as the optimal NBT. The optimal PVos diameters and elliptical area were determined using the receiver operating characteristic curve cutoff values for the optimal NBT. Results The maximum PVos diameter (PVmax), minimum PVos diameter (PVmin), and PV elliptical area correlated negatively with the NBT (PVmax: r = −.34, P < .0001; PVmin: r = −.41, P < .0001; PV elliptical area: r = −.41, P < .0001). Based on the NBT‐derived definition, the optimal PVmax, PVmin, and PV elliptical area were 19 < PVmax ≤ 21 mm, 14 < PVmin ≤ 16 mm, and 186.83 < PV elliptical area ≤ 254.34 mm2, respectively. In addition, a positive correlation between the LA longitudinal diameter and NBT was observed in the right superior PV (r = .34, P = .004), and the LA transverse diameter correlated inversely with the NBT in the left inferior PV (r = −.34, P = .004). Conclusions We identified the optimal PV diameters and elliptical area to establish the optimal NBT during the second‐generation 28‐mm CBA. These data will help for the preclinical judgment for a successful CBA.

Outcomes after cryoballoon ablation of paroxysmal atrial fibrillation with the PolarX or the Arctic Front Advance Pro: a prospective multicentre experience

“…This characteristic was thought to be an advantage to improve PV occlusion and avoid the pop-out phenomenon, improving balloon-to-tissue contact. 8 , 18 Despite that, our study confirmed that in experienced hands, the total number of freeze applications, and the applications for each PV did not differ between the two technologies.…”

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

“…26 While our study focused on mid-term outcomes following CBA, other studies have evaluated parameters of acute procedural success such as degree of occlusion and nadir balloon temperature in relation to PV diameters, ostial area and ovality indices. 12,16,27 Our study is a first of its kind evaluating whether the presence of an atypical PV anatomy or PV anatomic characteristics predict mid-term outcomes exclusively in paroxysmal AF patients. Although constrained by a small sample size, our results did not show any particular association between PV anatomy and CBA failure in paroxysmal AF patients.…”

“…(1) EI=PVmaxD/PVminD, 16 (2) OI = 2 x (PVmaxD-PVminD/PVmaxD+PVminD) 16 and 3PVA= π x PVmaxD x PVminD. PV EI values between 1.2-1.4 were representative of ovality while <1.2 were circular and > 1.4 considered as flat.…”

“…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.…”

Does a Vagal Response Indicate Cardiac Autonomic Modulation and Improve the Therapeutic Effect of Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation? Insights from Cryoballoon Ablation

“…The preprocedural anatomy of LA and PVs acquired with 64-row-multidetector computed tomography (CT) (Somatom Definition AS+, Siemens, Berlin, Germany) was available in 53% (156/296) of patients ( Figure 1 ). The following indices were obtained from multiplanar reconstructed images for each of the PVs using dedicated calliper software [ 19 ]: PV maximum (PVmax) and minimum (PVmin) ostial diameter, PV elliptical area calculated as (PVmax/2) × (PVmin/2) × 3.14 and the ovality index calculated as PVmax/PVmin.…”