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Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results

The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atri...

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Autores principales: Mamchur, Sergey, Chichkova, Tatiana, Khomenko, Egor, Kokov, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221566/
https://www.ncbi.nlm.nih.gov/pubmed/35741132
http://dx.doi.org/10.3390/diagnostics12061322
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author Mamchur, Sergey
Chichkova, Tatiana
Khomenko, Egor
Kokov, Alexander
author_facet Mamchur, Sergey
Chichkova, Tatiana
Khomenko, Egor
Kokov, Alexander
author_sort Mamchur, Sergey
collection PubMed
description The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atrial fibrillation (AF). We compared procedural and long-term outcomes in patients who underwent their first procedure of pulmonary vein isolation (PVI) for AF with either radiofrequency ablation (RFA) (n = 108) or CBA (n = 122) and assessed their interaction with the different pattern of PV anatomy, morphometric characteristics, and spatial orientation. The primary efficacy endpoint was any documented atrial arrhythmia recurrence (AF, atrial flutter, or atrial tachycardia) lasting over 30 s during a 12-month follow-up after a 90-day blanking period and discontinuation of antiarrhythmic drugs. The procedure’s endpoint was the achievement of PVI. Before the intervention, all patients underwent computed tomography (CT) to assess the PV anatomical variant, maximum and minimum diameters of the PV’s ostia, their cross-sectional area, orifice ovality index, and PV tilt angles. Results: The mean follow-up period was 14 months (12; 24). Long-term efficacy in the cryoablation group was 78.8% and in the RFA group—83.3% (OR = 0.74; 95% CI 0.41–1.3; p = 0.31). The RFA results did not depend on PV anatomy. The «difficult» occlusion of the right inferior PV (RIPV) occurred in 12 patients and was associated with a more horizontal PV position in the frontal plane; the mean tilt angle was −15.2 ± 6.2° versus −26.5 ± 6.3° in the absence of technical difficulties (p = 0.0001). In 11 cases (9%), during ablation of the right superior PV (RSPV), phrenic nerve injury (PNI) occurred and was associated with the maximum and minimum RSPV diameter, 20.0–20.4 mm (OR = 13.2; 95% CI: 4.7–41.9, p < 0.05) and 17.5–20 mm (OR = 12.5; 95% CI 3.4–51, p < 0.05), respectively. Patients with arrhythmia recurrence were characterized by significantly larger diameters and ovality of the left superior PV (LSPV). The spatial orientation of the PV does not affect the long-term results of cryoablation. Conclusion: Preprocedural evaluation of PV morphology and orientation using cardiac CT might help choose the optimal technology for the individual patient.
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spelling pubmed-92215662022-06-24 Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results Mamchur, Sergey Chichkova, Tatiana Khomenko, Egor Kokov, Alexander Diagnostics (Basel) Article The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atrial fibrillation (AF). We compared procedural and long-term outcomes in patients who underwent their first procedure of pulmonary vein isolation (PVI) for AF with either radiofrequency ablation (RFA) (n = 108) or CBA (n = 122) and assessed their interaction with the different pattern of PV anatomy, morphometric characteristics, and spatial orientation. The primary efficacy endpoint was any documented atrial arrhythmia recurrence (AF, atrial flutter, or atrial tachycardia) lasting over 30 s during a 12-month follow-up after a 90-day blanking period and discontinuation of antiarrhythmic drugs. The procedure’s endpoint was the achievement of PVI. Before the intervention, all patients underwent computed tomography (CT) to assess the PV anatomical variant, maximum and minimum diameters of the PV’s ostia, their cross-sectional area, orifice ovality index, and PV tilt angles. Results: The mean follow-up period was 14 months (12; 24). Long-term efficacy in the cryoablation group was 78.8% and in the RFA group—83.3% (OR = 0.74; 95% CI 0.41–1.3; p = 0.31). The RFA results did not depend on PV anatomy. The «difficult» occlusion of the right inferior PV (RIPV) occurred in 12 patients and was associated with a more horizontal PV position in the frontal plane; the mean tilt angle was −15.2 ± 6.2° versus −26.5 ± 6.3° in the absence of technical difficulties (p = 0.0001). In 11 cases (9%), during ablation of the right superior PV (RSPV), phrenic nerve injury (PNI) occurred and was associated with the maximum and minimum RSPV diameter, 20.0–20.4 mm (OR = 13.2; 95% CI: 4.7–41.9, p < 0.05) and 17.5–20 mm (OR = 12.5; 95% CI 3.4–51, p < 0.05), respectively. Patients with arrhythmia recurrence were characterized by significantly larger diameters and ovality of the left superior PV (LSPV). The spatial orientation of the PV does not affect the long-term results of cryoablation. Conclusion: Preprocedural evaluation of PV morphology and orientation using cardiac CT might help choose the optimal technology for the individual patient. MDPI 2022-05-26 /pmc/articles/PMC9221566/ /pubmed/35741132 http://dx.doi.org/10.3390/diagnostics12061322 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mamchur, Sergey
Chichkova, Tatiana
Khomenko, Egor
Kokov, Alexander
Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results
title Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results
title_full Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results
title_fullStr Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results
title_full_unstemmed Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results
title_short Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results
title_sort pulmonary veins morphometric characteristics and spatial orientation influence on its cryoballoon isolation results
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221566/
https://www.ncbi.nlm.nih.gov/pubmed/35741132
http://dx.doi.org/10.3390/diagnostics12061322
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