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Impact of pulmonary veins anatomy on outcome of cryoablation or radiofrequency catheter ablation for atrial fibrillation
Session:
CO 13- Atrial fibrilation
Speaker:
Gualter Santos Silva
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gualter Santos Silva; Pedro Ribeiro Queirós; Mariana Ribeiro da Silva; Rafael Teixeira; João Almeida; Paulo Fonseca; Marco Oliveira; Helena Gonçalves; João Primo; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pulmonary vein isolation is the cornerstone of interventional treatment of atrial fibrillation (AF). Pulmonary veins frequently display anatomic variants. If this influences the recurrence of AF after catheter ablation is still a matter of debate.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our aim was to determine if pulmonary vein anatomy variants influences the recurrence of AF after catheter ablation with radiofrequency or cryoablation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of patients with paroxysmal or persistent atrial fibrillation who underwent pulmonary vein isolation by radiofrequency (RF) or cryoablation (CA) in a single center between January 2017 and September 2019. All patients underwent computed tomography before AF ablation. Within each treatment group (RF or CA), patients were stratified according to their PV anatomy in: regular (2 left PVs and 2 right PVs) or variant (left common trunk, right common trunk, bilateral common trunk, right intermediate branch or other). The primary end-point was 1-year recurrence of AF. Recurrence was defined as electrical documented AF.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 425 patients (RF=300 and CA=125), aged 56.6 ± 11.7 years, 277 men (65.0%) were enrolled. The majority of patients had paroxysmal AF (n=343, 81.5%). Mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score was 1.12 ± 1.28. Regular PV anatomy was identified in 357 patients (84.0%), a left common trunk in 53 patients (12.5%), a bilateral common trunk in 5 patients (1.2%), a right intermediate branch in 3 patients (0.7%) and other mixed variants in 7 patients (1.6%). There were no significant differences in the baseline clinical and echocardiographic characteristics between groups.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At 1-year follow-up, patients with atypical PV anatomy had more AF recurrence (regular 8.1% vs variant 16.2%; p=0.037). Analyzing according to the ablation technique there was no difference in AF recurrence between PV anatomy groups in patients submitted to radiofrequency (regular 8.3% vs variant 13.0%; p=0.252). On the other hand, in cryoablation group, patients with PV anatomic variant had significantly higher rates of 1-year AF recurrence (regular 7.8% vs variant 22.8%; p= 0.033).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The presence of atypical PVs anatomy seems to be associated with higher rates of AF recurrence at 1-year in patients undergoing cryoablation. Further prospective studies are needed to confirm the PV anatomy impact in the success of the procedure and if this needs to be accounted in the choice of ablation technique.</span></span></p>
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