| PURPOSE:1.The results of cryoballoon ablation(CBA)with the second-generation cryoballoon(CB2)for atrial fibrillation(AF)with variant pulmonary vein anatomy(PVA),especially the left common pulmonary vein(LCPV),have not yet been clarified.The purpose of this study is to find out whether LCPV can influence the acute outcome of CB2-based CBA for AF,and its effect on pulmonary vein isolation(PVI)2.Variant PVA was considered to be a risk factor for AF recurrence after radiofrequency ablation(RFA),but it was still unclear on the long-term outcome of CB2 ablation for LCPV.The aim of our study is to compare the long-term outcomes of LCPV wtih non-LCPV patients,and to find out the parameters of pulmonary vein(PV)that may affect the long-term efficacyPATIENTS AND METHODS:1.A total of 159 patients(mean age 60.1±10.0 years,61.6%males)with symptomatic and drug-refractory AF for CBA in our hospital from August 2016 to August 2017 were included.Left atrium(LA)and PVA acquired at computed tomography angiography(CTA)were reconstructed with CARTO(?)3 SYSTEM.Acute ablation data of CB2,including freezing temperature and the time to PVI,were recorded to compare the acute-outcomes of CBA for LCPV and non-LCPV2.159 Patients were routinely evaluated by 24-hour Holter monitoring following CBA Cox’s regression was used to detect the predictors of AF recurrence after CBA,comparing the difference of success rate between LCPV and non-LCPV patientsRESULTS:1.46(28.9%)patients were LCPV and 113(71.0%)patients had two individual PVs 272(100%)left PVs achieved complete PVI.35(76.1%)LCPVs in the LCPV group were observed for PVP isolation during CBA,which was a 137(60.6%)in the Control group.LCPV took longer time to efficacy than that of LIPV(46.9±19.7 vs 33.3±18.7 s,P=0.001)and the effective temperature of LCPV was lower than that of LIPV(-33.0±9.5 vs-27.7±7.8℃,P=0.006).A significantly negative linear correlation between the time to efficacy and the effective temperature were observed in LCPV,LSPV and LIPV,respectivly(r=-0.801,r=-0.734,r=-0.710,P<0.001)2.Among 46 patients of LCPV,76.1%(35 cases)were paroxysmal AF and 23.9%(11 cases)were persistent AF.As to 113(71.0%)patients of the Control group,68.1%(77 cases)were paroxysmal AF and 31.9%(36 cases)were persistent AF.After a follow-up of 293.1±126.2 days,a total of 125(78.6%)patients were sinus rhythm off AAD after a single procedure.Overall success rate of the LCPV group was no differ from the Control group(78.3%vs 78.8%,P=0.94).Cox regression analysis showed that longer AF duration(66.4±68.lvs 40.7±51.1months,P=0.017),lower freezing temperature on left-side PVs(-37.6±4.9vs-40.6±5.7℃,P=0.007),longer length of PV-LAA ridge(37.4±3.6vs 34.0±4.7mm,P=0.04)were independent predictors of freedom from AF,but didn’t identify LCPV as predictors of long-term recurrenceCONCLUSION:1.CB2 ablation for AF with or without LCPV can achieve 100%PVI.Time to efficacy of LCPV is significantly longer than that of non-LCPV,and the effective temperature is lower in LCPV than in non-LCPV.Although he lowest temperature in LCPVs is higher than in non-LCPVs,the presence of LCPV has no effect on acute outcome of PVI in CB2-based CBA2.The LCPV could not significantly influence the long-term outcome of AF patients undergoing CB2-based CBA.Regardless of PVA,longer AF duration,lower freezing temperature of left-side PVs and longer length of PV-LAA ridge are associated with higher AF recurrent rate. |
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