Correlation Analysis of Pulmonary Vein Anatomy and Paroxysmal Atrial Fibrillation Recurrence after Cryoballoon Ablation

Abstract

Background: Cryoballoon ablation (CBA) is a reliable therapy for paroxysmal atrial fibrillation (pAF). However, the relatively high recurrence rate poses a perplexing challenge for clinicians; thus, a more detailed understanding of the pulmonary vein anatomy and the left atrial (LA)-pulmonary vein (PV) conjunction mode is needed. This study aimed to explore the correlation between the PV anatomy and pAF recurrence in patients who underwent the index CBA. Methods: We included 274 consecutive pAF patients (men: 60%, mean age: 58.8 ± 11.5 years, median AF history: 25 (8, 63) months) with pAF who underwent their first cryoballoon ablation between October 2019 and March 2022. All data were collected from the patient’s medical records. Subsequent post-procedural long-term follow-up and statistical analysis were conducted. Results: Amongst the total patients, 220 (80%) remained AF-free. Multivariate analysis showed that the right inferior PV (RIPV) vertical angle (hazard ratio (HR): 1.097, 95% CI: 1.071–1.124, p < 0.001) and PV variation (HR: 1.905, 95% CI: 1.079–3.362, p = 0.026) correlated with postoperative AF recurrence. The study investigated the effectiveness of the RIPV vertical angle, either alone or in combination with other recognized factors. Conclusions: In patients with pAF who underwent the index CBA, the RIPV vertical angle and PV variation served as reliable prognostic predictors. Specifically, the RIPV vertical angle, either alone or in combination with recognized factors, demonstrated effective predictive performance.