Impact of pulmonary vein anatomy on cryoballoon isolation results

Aim. To estimate the efficacy of pulmonary veins (PV) cryoballoon isolation in its different anatomical variants.

Methods. 230 patients 57 (53; 62) years of age were enrolled in the study in approximately equal proportion of males and females. Up to 1/3 of patients suffered from isolated AF, most of them belonged to the category of high risk of thromboembolic complications. To evaluate the PV anatomical variant, a modified classification of E. Marom et al was used. In groups of cryoballoon and radio-frequency isolation, subgroups of typical and variant anatomy were distinguished. Evaluation of the effectiveness of the intervention was based on the identification of any (symptomatic and asymptomatic) documented episodes of atrial arrhythmias lasting more than 30 seconds during the observation period of 12 months.

Results. Comparison of efficacy in typical PV anatomy did not reveal significant differences between cryo and RFA groups, regardless of the type of device used. Subgroup I of generation of cryoballoons showed freedom from AF 83.2%, II generation – 87.5%, RFA group – 82.7% at p = 0.82. At the same time, with PV variant anatomy, the efficiency of cryo isolation with the use of II generation devices was 52.2 versus 85.7% in the RFA group (OR = 0.25; 95% CI 0.09–0.71; p = 0, 02). When analyzing long-term results in cryo and RFA groups depending on the anatomical variant, it was found that with RFA, the presence of a left PV common trunk (collector / vestibule), as well as the presence of additional veins, showed results comparable with the group of typical anatomy. At the same time, in the cryoablation group, the presence of a left common trunk was accompanied by a decrease in efficiency to 23.1 versus 84.9% for typical anatomy (OR = 0.14; 95% CI 0.03–0.6; p = 0.02) and 90% in the presence of additional veins (OR = 0.1; 95% CI 0.01–0.64; p = 0.02). In the presence of a left common trunk, the efficiency of cryoablation using second-generation cylinders was 23.1 versus 82.4% in the RFA group (OR = 0.16; 95% CI 0.05–0.5).

Conclusion. The presence of a left PV common trunk leads to a decrease in the effectiveness of cryoablation in the long-term observation period relative to the group of typical anatomy to 23.1 versus 84.9% (OR = 0.14; 95% CI 0.03–0.6) and 82.4% for radiofrequency ablation (OR = 0.16; 95% CI 0.05–0.5). The presence of additional veins of right-sided localization does not affect the effectiveness of the intervention.

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