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Szegedi N, Vecsey-Nagy M, Simon J, Szilveszter B, Herczeg S, Kolossváry M, Idelbi H, Osztheimer I, Klaudia Nagy V, Tahin T, Széplaki G, Delgado V, Bax JJ, Maurovich-Horvat P, Merkely B, Gellér L. Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation. Eur Heart J Cardiovasc Imaging 2021; 23:515-523. [PMID: 33693618 DOI: 10.1093/ehjci/jeab041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique. METHODS AND RESULTS We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P > 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15-2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19-0.71, P = 0.003). CONCLUSION Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.
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Affiliation(s)
- Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Szilvia Herczeg
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - Hana Idelbi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Vivien Klaudia Nagy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Tamás Tahin
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, 2 Albinusdreef, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, 2 Albinusdreef, 2333 ZA Leiden, The Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungar.,Department of Radiology, Medical Imaging Center, Semmelweis University, 2 Koranyi Sandor Street, 1082 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122 Budapest, Hungary
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Kocyigit D, Yalcin MU, Gurses KM, Selin Ardali, Turk G, Canpolat U, Evranos B, Yorgun H, Hazirolan T, Aytemir K. Pulmonary vein orientation is independently associated with outcomes following cryoballoon-based atrial fibrillation ablation. J Cardiovasc Comput Tomogr 2018; 12:281-285. [PMID: 29500095 DOI: 10.1016/j.jcct.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/13/2018] [Accepted: 01/23/2018] [Indexed: 01/10/2023]
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Gal P, Buist TJ, Smit JJJ, Adiyaman A, Ramdat Misier AR, Delnoy PPHM, Elvan A. Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation. Neth Heart J 2016; 25:16-23. [PMID: 27752967 PMCID: PMC5179364 DOI: 10.1007/s12471-016-0907-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Pulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation. Methods 50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLDTM, Medtronic Inc.) ablation. The Gold-MEA catheter was navigated to the PV ostium by fluoroscopy. Duty-cycled radiofrequency ablations were performed at all PV ostia. Lesions were considered transmural when electrode temperature was >50 °C and power >3 W for >30 seconds. After the ablation procedure, patients visited the outpatient clinic at 3‑month intervals including 24-hour Holter ECGs. Results Mean age was 56 years. All PVs were acutely isolated with the Gold-MEA catheter. Procedure time was 111 ± 22 minutes, ablation time was 24 ± 6.7 minutes and fluoroscopy time was 20 ± 8.1 minutes. No procedure-related complications were observed. One year after ablation, 60 % of patients were still free of arrhythmia recurrences after a single PV isolation attempt. The number of transmural lesions was associated with arrhythmia-free survival: 25.0 % in <72 transmural lesions, 64.3 % in 72–108 transmural lesions and 71.4 % in >108 transmural lesions (p = 0.029). Conclusion PV isolation can be performed successfully with the Gold-MEA catheter, with a favourable safety profile. Transmurality of lesions was associated with ablation success and may improve AF ablation success.
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Affiliation(s)
- P Gal
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - T J Buist
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - J J J Smit
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - A Adiyaman
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | | | - P P H M Delnoy
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
| | - A Elvan
- Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
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