nach oben

Journal of Interventional Cardiac Electrophysiology

Erschienen in:

17.10.2022

Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters

verfasst von: Karim Benali, Van Duc Lai, Nefissa Hammache, Isabelle Magnin-Poull, Christian de Chillou, Jean-Marc Sellal

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Pulmonary vein (PV) isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF). PVI durability is influenced by many factors including PVs anatomy. Data regarding the influence of PVs anatomical variations on the outcomes of PAF ablation in the era of contact force-sensing ablation catheters are scarce and contradictory.

Methods

Consecutive patients referred to our center for a first ablation of PAF using radiofrequency (RF) were included. PVs anatomy was classified into 3 groups: typical anatomy (4 distinct veins), left common ostium (LCO), and right accessory PV (RAPV). The primary outcome was recurrence of atrial arrhythmia episode during a 12-month follow-up after ablation.

Results

Two hundred twenty-three patients were included (mean age 58.4 ± 10.8 years and 70.9% male). Among this cohort, 141 patients (63.2%) had typical PV anatomy, 53 (23.8%) had a LCO, and 29 (13.0%) had a RAPV. The existence of a RAPV was not associated with a higher rate of AF recurrences (22 (14.3%) vs. 7 (10.1%), p = 0.519). After multivariate analysis, the presence of an LCO did not appear to be associated with the AF recurrence rate at 12 months (OR = 1.69, 95%CI 0.95–2.49, p = 0.098). Maintenance of antiarrhythmic drugs after ablation was the only factor independently associated with a decreased risk of AF recurrence at 12 months (OR = 0.76, 95%CI 0.60–0.97, p = 0.046).

Conclusion

This study suggests that the presence of an LCO or a RAPV is not associated with a higher rate of AF recurrence at 12 months after radiofrequency PVI using contact force-sensing catheters in PAF patients.

Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127:4–20. https://doi.org/10.1161/CIRCRESAHA.120.316340.CrossRefPubMedPubMedCentral

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373–498. https://doi.org/10.1093/eurheartj/ehaa612.CrossRefPubMed

January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, et al. AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;2019:140. https://doi.org/10.1161/CIR.0000000000000665.CrossRef

Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66. https://doi.org/10.1056/NEJM199809033391003.CrossRefPubMed

Verma A, Kilicaslan F, Pisano E, Marrouche NF, Fanelli R, Brachmann J, et al. Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation. 2005;112:627–35. https://doi.org/10.1161/CIRCULATIONAHA.104.533190.CrossRefPubMed

McLellan AJA, Ling L, Ruggiero D, Wong MCG, Walters TE, Nisbet A, et al. Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2014;11:549–56. https://doi.org/10.1016/j.hrthm.2013.12.025.CrossRefPubMed

Larsen JM, Deyell MW, Macle L, Champagne J, Sarrazin J, Leong-Sit P, et al. Impact of left common pulmonary veins in the contact force versus cryoballoon atrial fibrillation ablation (CIRCA-DOSE) study. J Cardiovasc Electrophysiol. 2020;31:2300–7. https://doi.org/10.1111/jce.14652.CrossRef

Pichard C, Nicolas A, Galand V, Coquard C, Behar N, Chérel C, et al. Cryoballoon ablation of atrial fibrillation in patients with atypical right pulmonary vein anatomy. Arch Cardiovasc Dis. 2020;113:690–700. https://doi.org/10.1016/j.acvd.2020.05.008.CrossRefPubMed

Benali K, Da Costa A, Macle L, Hammache N, Galand V, Romeyer C, et al. Distance between the descending aorta and the left inferior pulmonary vein as a determinant of biophysical parameters during paroxysmal atrial fibrillation cryoablation. J Cardiovasc Electrophysiol. 2021;32:2943–52. https://doi.org/10.1111/jce.15234.CrossRefPubMed

10.

Ronsoni RM, Silvestrini TL, Essebag V, Lopes RD, Lumertz Saffi MA, Luz Leiria TL. Association of the left common ostium with clinical outcome after pulmonary vein isolation in atrial fibrillation. Indian Pacing Electrophysiol J. 2021;21:95–100. https://doi.org/10.1016/j.ipej.2020.11.020.CrossRefPubMed

11.

Sohns C, Sohns JM, Bergau L, Sossalla S, Vollmann D, Luthje L, et al. Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation. Europace. 2013;15:1136–42. https://doi.org/10.1093/europace/eut059.CrossRefPubMed

12.

den Uijl DW, Tops LF, Delgado V, Schuijf JD, Kroft LJM, de Roos A, et al. Effect of Pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol. 2011;107:243–9. https://doi.org/10.1016/j.amjcard.2010.08.069.CrossRef

13.

Neuzil P, Reddy VY, Kautzner J, Petru J, Wichterle D, Shah D, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I Study. Circ Arrhythm Electrophysiol. 2013;6:327–33. https://doi.org/10.1161/CIRCEP.113.000374.CrossRefPubMed

14.

Kuck K-H, Reddy VY, Schmidt B, Natale A, Neuzil P, Saoudi N, et al. A novel radiofrequency ablation catheter using contact force sensing: Toccata study. Heart Rhythm. 2012;9:18–23. https://doi.org/10.1016/j.hrthm.2011.08.021.CrossRefPubMed

15.

Kimura M, Sasaki S, Owada S, Horiuchi D, Sasaki K, Itoh T, et al. Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: a prospective, randomized study. Heart Rhythm. 2014;11:984–91. https://doi.org/10.1016/j.hrthm.2014.03.019.CrossRefPubMed

16.

Marom EM, Herndon JE, Kim YH, McAdams HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230:824–9. https://doi.org/10.1148/radiol.2303030315.CrossRefPubMed

17.

Perino AC, Leef GC, Cluckey A, Yunus FN, Askari M, Heidenreich PA, et al. Secular trends in success rate of catheter ablation for atrial fibrillation: the SMASH-AF cohort. Am Heart J. 2019;208:110–9. https://doi.org/10.1016/j.ahj.2018.10.006.CrossRefPubMed

18.

Mlcochova H, Tintera J, Porod V, Peichl P, Cihak R, Kautzner J. Magnetic resonance angiography of pulmonary veins: implications for catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2005;28:1073–80. https://doi.org/10.1111/j.1540-8159.2005.00228.x.CrossRefPubMed

19.

Kaseno K, Tada H, Koyama K, Jingu M, Hiramatsu S, Yokokawa M, et al. Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. Am J Cardiol. 2008;101:1638–42. https://doi.org/10.1016/j.amjcard.2008.01.053.CrossRefPubMed

20.

Wittkampf FHM, Vonken E-J, Derksen R, Loh P, Velthuis B, Wever EFD, et al. Pulmonary vein ostium geometry: analysis by magnetic resonance angiography. Circulation. 2003;107:21–3. https://doi.org/10.1161/01.CIR.0000047065.49852.8F.CrossRefPubMed

21.

Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G, et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation. 2003;107:2004–10. https://doi.org/10.1161/01.CIR.0000061951.81767.4E.CrossRefPubMed

22.

Stanford W, Breen JF. CT evaluation of left atrial pulmonary venous anatomy. Int J Cardiovasc Imaging. 2005;21:133–9. https://doi.org/10.1007/s10554-004-5347-5.CrossRefPubMed

23.

Beiert T, Lodde PC, Linneborn LPT, Werner J, Prinz L, Stöckigt F, et al. Outcome in patients with left common pulmonary vein after cryoablation with second-generation cryoballoon. Pacing Clin Electrophysiol. 2018;41:22–7. https://doi.org/10.1111/pace.13247.CrossRefPubMed

24.

Kubala M, Hermida J-S, Nadji G, Quenum S, Traulle S, Jarry G. Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein: COMMON LEFT PULMONARY VEIN. Pacing Clin Electrophysiol. 2011;34:837–43. https://doi.org/10.1111/j.1540-8159.2011.03070.x.CrossRefPubMed

25.

Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Pulmonary vein anatomy and long-term outcome after multi-electrode pulmonary vein isolation with phased radiofrequency energy for paroxysmal atrial fibrillation. Europace. 2011;13:1557–61. https://doi.org/10.1093/europace/eur236.CrossRefPubMed

26.

Hof I, Chilukuri K, Arbab-Zadeh A, Scherr D, Dalal D, Nazarian S, et al. Does left atrial volume and pulmonary venous anatomy predict the outcome of catheter ablation of atrial fibrillation? J Cardiovasc Electrophysiol. 2009;20:1005–10. https://doi.org/10.1111/j.1540-8167.2009.01504.x.CrossRefPubMed

27.

Woźniak-Skowerska I, Skowerski M, Wnuk-Wojnar A, Hoffmann A, Nowak S, Gola A, et al. Comparison of pulmonary veins anatomy in patients with and without atrial fibrillation: analysis by multislice tomography. Int J Cardiol. 2011;146:181–5. https://doi.org/10.1016/j.ijcard.2009.06.047.CrossRefPubMed

28.

Lin W-S, Prakash VS, Tai C-T, Hsieh M-H, Tsai C-F, Yu W-C, et al. Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: implications for catheter ablation. Circulation. 2000;101:1274–81. https://doi.org/10.1161/01.CIR.101.11.1274.CrossRefPubMed

29.

Tsao H-M, Yu W-C, Cheng H-C, Wu M-H, Tai C-T, Lin W-S, et al. Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging. J Cardiovasc Electrophysiol. 2001;12:809–13. https://doi.org/10.1046/j.1540-8167.2001.00809.x.CrossRefPubMed

30.

Schwartzman D, Bazaz R, Nosbisch J. Common left pulmonary vein: a consistent source of arrhythmogenic atrial ectopy. J Cardiovasc Electrophysiol. 2004;15:560–6. https://doi.org/10.1046/j.1540-8167.2004.03351.x.CrossRefPubMed

31.

Bittner A, Monnig G, Vagt AJ, Zellerhoff S, Wasmer K, Kobe J, et al. Pulmonary vein variants predispose to atrial fibrillation: a case-control study using multislice contrast-enhanced computed tomography. Europace. 2011;13:1394–400. https://doi.org/10.1093/europace/eur145.CrossRefPubMed

32.

Satoh T, Zipes DP. Unequal atrial stretch in dogs increases dispersion of refractoriness conducive to developing atrial fibrillation. J Cardiovasc Electrophysiol. 1996;7:833–42. https://doi.org/10.1111/j.1540-8167.1996.tb00596.x.CrossRefPubMed

33.

Xu B, Xing Y, Xu C, Peng F, Sun Y, Wang S, et al. A left common pulmonary vein: anatomical variant predicting good outcomes of repeat catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30:717–26. https://doi.org/10.1111/jce.13876.CrossRefPubMed

34.

Aursulesei S, Cismaru G, Rosu R, Puiu M, Gusetu G, Zdrenghea D, Pop D. P995 The effect of pulmonary vein anatomy on outcome of catheter ablation for atrial fibrillation. Eur Heart J. 2018;39(suppl_1):ehy564.P995. https://doi.org/10.1093/eurheartj/ehy564.P995.

35.

Khoueiry Z, Albenque J-P, Providencia R, Combes S, Combes N, Jourda F, et al. Outcomes after cryoablation vs. radiofrequency in patients with paroxysmal atrial fibrillation: impact of pulmonary veins anatomy. Europace. 2016;18:1343–51. https://doi.org/10.1093/europace/euv419.CrossRefPubMed

36.

Istratoaie S, Roşu R, Cismaru G, VesaŞtefan C, Puiu M, Zdrenghea D, et al. The impact of pulmonary vein anatomy on the outcomes of catheter ablation for atrial fibrillation. Medicina (Mex). 2019;55:727. https://doi.org/10.3390/medicina55110727.CrossRef

37.

Haïssaguerre M, Wright M, Hocini M, Jaïs P. The substrate maintaining persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2008;1:2–5. https://doi.org/10.1161/CIRCEP.108.764233.CrossRefPubMed

38.

Hunter RJ, Ginks M, Ang R, Diab I, Goromonzi FC, Page S, et al. Impact of variant pulmonary vein anatomy and image integration on long-term outcome after catheter ablation for atrial fibrillation. Europace. 2010;12:1691–7. https://doi.org/10.1093/europace/euq322.CrossRefPubMed

39.

Gerstenfeld EP. Contact force–sensing catheters: evolution or revolution in catheter ablation technology? Circ Arrhythm Electrophysiol. 2014;7:5–6. https://doi.org/10.1161/CIRCEP.114.001424.CrossRefPubMed

40.

Natale A, Reddy VY, Monir G, Wilber DJ, Lindsay BD, McElderry HT, et al. Paroxysmal AF catheter ablation with a contact force sensing catheter. J Am Coll Cardiol. 2014;64:647–56. https://doi.org/10.1016/j.jacc.2014.04.072.CrossRefPubMed

Titel: Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters
verfasst von: Karim Benali
Van Duc Lai
Nefissa Hammache
Isabelle Magnin-Poull
Christian de Chillou
Jean-Marc Sellal
Publikationsdatum: 17.10.2022
Verlag: Springer US
Erschienen in: Journal of Interventional Cardiac Electrophysiology / Ausgabe 4/2023
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-022-01393-9

Neu im Fachgebiet Kardiologie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

28.05.2024 Nebenwirkungen der Krebstherapie Nachrichten

Kardiotoxische Nebenwirkungen einer Therapie mit Immuncheckpointhemmern mögen selten sein – wenn sie aber auftreten, wird es für Patienten oft lebensgefährlich. Voruntersuchung und Monitoring sind daher obligat.

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

24.05.2024 Diabetische Retinopathie Nachrichten

Möglicherweise hängt es von der Art der Diabetesmedikamente ab, wie hoch das Risiko der Betroffenen ist, dass sich sehkraftgefährdende Komplikationen verschlimmern.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters

Abstract

Background

Methods

Results

Conclusion

Neu im Fachgebiet Kardiologie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

Update Kardiologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2023

Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

Cardiac surgery in patients with cardiac implantable electronic devices and risk of device infections: a nationwide nested case–control study

Group beating with phase 4 deceleration-dependent aberrancy

Hospital outcomes of patients receiving catheter ablation of atrial fibrillation, left atrial appendage closure, or both

Evaluation of the direction and extent of ice formation during cryoballoon ablation: an experimental study

Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (the Achieve Plus study)

Neu im Fachgebiet Kardiologie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

Update Kardiologie