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Pulmonary veins anatomy variants and cryoballoon ablation for atrial fibrillation
Session:
Sessão de Posters 13 - Ablação de fibrilhação auricular
Speaker:
Ana Rita Teixeira
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Rita Teixeira; Pedro Silva Cunha; Ana Lousinha; Guilherme Portugal; Bruno Valente; Madalena Coutinho Cruz; Ana Sofia Delgado; Manuel Brás; Margarida Paulo; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:</span></strong><span style="color:black"> Cryoballoon ablation (CBA) has consistently demonstrated a reduction of atrial fibrillation (AF) recurrence, without increasing the risk of adverse events. Pulmonary veins (PV) frequently exhibit anatomic variants that may make the ablation procedure using the cryoballoon approach difficult. We aimed to evaluate whether PV anatomy variants influence the safety and success of CBA, and the AF recurrence. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> A single-centre retrospective study was conducted, including all patients (pts) with AF who underwent CBA between 2010 and 2020. Pts were stratified according to their PV anatomy into regular (2 left PVs and 2 right PVs) or variant. Arrhythmia recurrence was defined as any episodes of AF, atrial flutter, or atrial tachycardia lasting >30 seconds, and occurring after 90 days of CBA. Demographic, clinical and procedure related data were retrieved. Groups were compared using Chi-square and Mann-Whitney analysis. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results:</span></strong><span style="color:black"> A total of 193 pts were included, 61% males, with a mean age of 57±13 years. Paroxysmal AF was found in 154 pts. Most </span><span style="color:#212529">were treated with an antiarrhythmic drug (65.8%)</span><span style="color:black">. </span>Regular PV anatomy was identified in 128 patients (66.3%), a left common trunk in 35 patients (18.1%), a right common trunk in 7 patients (3.6%), a right intermediate branch in 17 patients (8.8%) and other mixed variants in 6 patients (3.1%). There were no significant differences in the baseline clinical and echocardiographic characteristics between groups. Procedural complications occurred in 14 pts (7,2%). There was no difference between groups regarding the procedure time or radiation dose. However, atypical PV anatomy seems to be significantly associated with higher complication rates (15.4% vs 4.7%, p=0.011). During a follow-up of <span style="color:black">16±15 months, AF recurrence was present in 58 pts (30%), and, despite a trend to a higher recurrence rate, it was not significantly different when comparing typical and atypical PV groups (25.8% vs. 38.5%, p=0.069, respectively). The success rate at one year was 85.5%. At 1-year follow-up, </span><span style="color:#212529">patients with atypical PV anatomy did not exhibit significantly higher rates of AF recurrence (regular 10.9% vs variant 20%; p=0.086). </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> CBA <span style="color:#333333">is a safe and successful procedure. The presence of atypical PV anatomy seems to be associated with an increased risk of procedure complications, but it is not correlated with higher rates of AF recurrence at 1 year.</span></span></span></p>
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