Impact of pulmonary vein anatomy and ostial dimensions on long term outcome after single-shot device guided cryoablation for paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). Purpose Assessment of the role of individual anatomical characteristics to predict long-term freedom from arrhythmia recurrence after CB-guided PVI for paroxysmal AF (PAF). Methods 353 consecutive patients (58±11 years, 56% males), undergoing PVI between 2012 and 2018 were analysed. Individual pulmonary vein (PV) anatomy was assessed using preprocedural cardiac magnetic resonance imaging (MRI). The impact of PV characteristics and CSA on long-term AF-free survival was evaluated. Results Acute PVI was achieved in all patients. 223 patients (63%) had a normal PV anatomy. Variant PV anatomy was present in 130 patients (37%). During the observation period of 48 months AF-recurrence was documented in 167 patients (47 %). Patients with AF-recurrence presented with significantly enlarged right-sided PVs and left superior PVs (LSPVs) (p<0.001). The presence of left common PVs (LCPVs) (n=75, Log-rank p<0.001) as well as right variant PVs (n=35, Log rank p<0.001) was associated with a significantly worse long-term AF-free survival rate compared to patients with normal PV characteristics. Conclusion Variant PV anatomy predicted long-term AF-recurrence. Preprocedural imaging may help to improve patients’ selection for single-shot device guided PVI.