Correlation Between Pulmonary Vein Anatomy And Recurrence Of Atrial Fibrillation After Cryoballoon Ablation

Background: Venous-atrial junction is electrically active and believed to be responsible for initiation and maintenance of atrial fibrillation(AF).Based on these theories,circumferential pulmonary vein isolation(CPVI)has become the cornerstone of interventional treatment of AF.But during the follow-up,AF recurrence rate is relatively high.It is supposed to be related to the pulmonary vein(PV)-left atrium(LA)reconnection.PV anatomy is closely related to cryoballoon ablation(CBA),but there lack researches on the relationship between PV anatomy and AF recurrence domestically.Aims: The aim of this study is to explore the impact of PV anatomy on AF recurrence in AF cohort completing index CBA.Methods: From 156 patients who completed index cryoballoon ablation from Oct.2019 to Mar.2021,126 eligible patients were enrolled.The data were collected from patients’ pre-and post-operation medical profiles.Demographic data,pulmonary vein anatomical characteristics,procedural parameters,etc.between the recurrence and non-recurrence group were analyzed to figure out the value of each parameter in predicting AF recurrence after CBA.Results: 43(34%)patients experienced episodes of atrial arrhythmia after 3-month blanking period.The average age is 57.6±11.6 years old and25(58%)male patients in recurrence group.Patients in the recurrence group showed more PV anatomic variations(49% vs.25%,p = 0.012),bigger right inferior PV(RIPV)eccentricity(0.59±0.19 vs.0.50±0.19,p =0.023),bigger RIPV vertical angle(VA)(93.3±12.6° vs.86.3±14.7°,p =0.011),more LA diameter over 40mm(60% vs.36%,p = 0.009),but less history of stroke(5% vs.20%,p = 0.005)and thus,less CHA2DS2-VASc score ≥ 3(14% vs.33%,p = 0.014).Multivariate Cox hazard analysis demonstrated that RIPV eccentricity(HR 9.600,95% CI: 1.605-57.418,p= 0.013),RIPV VA(HR 1.029,95% CI: 1.005-1.054,p = 0.017),and variation(HR 2.384,95% CI: 1.263-4.500,p = 0.007)were correlated with AF recurrence.The receiver-operating characteristic analysis showed that RIPV eccentricity(area under curve: 0.647,95% CI: 0.541-0.752,cutoff point: 0.545,sensitivity: 75%,specificity: 57%,p = 0.009)and RIPV VA(area under curve: 0.661,95% CI: 0.558-0.765,cutoff point: 91.5°,sensitivity: 67.5%,specificity: 63.3%,p = 0.004)were both effective predictors for AF recurrence after CBA.Conclusions: Anatomic variation of PV is common among AF patients who completed index CBA,right middle pulmonary vein the most.The eccentricity and VA of RIPV and PV anatomic variation are authentic predictors of AF recurrence after CBA.