Predictors of late pulmonary vein reconnection in patients with arrhythmia recurrence after cryoballoon ablation—per vein analysis including cardiac computed tomography–based anatomic factors

Abstract

ABSTRACT Aims To identify predictors of individual late pulmonary vein (PV) reconnection after second-generation cryoballoon (CB2) ablation. Anatomic indicators of late pulmonary vein reconnection (LPVR) post-CB2 ablation have not yet been studied on an individual PV level, nor weighed against clinical and procedural factors. Methods and results Clinical, procedural, and PV anatomic data from 125 patients with a repeat procedure for arrhythmia recurrence after index CB2 ablation were analyzed. Preprocedural computed tomography (CT) evaluated 486 PVs for measurement of size; shape (ovality index); carina width; and orientation angle in frontal (superior/inferior) and transversal (anterior/posterior) plane (with horizontal line 0° as reference and upper/lower half circle as positive/negative value, respectively). Durable isolation in all PVs was demonstrated in 50/125 (40%) patients. Late reconnection rates at the different PVs were as follows: 16% left superior (LS), 12% left inferior (LI), 17% right superior (RS), and 31% right inferior (RI) PV. Multivariable analysis performed per vein showed following independent determinants predicting LPVR: ovality index [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.07–2.41, P = 0.022] and carina width (OR 0.75, CI 0.59–0.96, P = 0.024) for LSPV; carina width (OR 0.71, CI 0.53–0.95, P = 0.020) for LIPV; frontal angle (OR 0.91, CI 0.87–0.95, P < 0.001) for RIPV; and transversal angle (OR 1.15, CI 1.03–1.31, P = 0.032) for RSPV. Conclusion Cardiac CT-based evaluation of anatomic PV characteristics presented higher predictive value compared to clinical and procedural variables for individual LPVR after CB2 ablation. Pre-procedural identification of unfavourable PV anatomy might be important to tailor the ablation approach.