Anatomic predictors of late right inferior pulmonary vein reconnection in the setting of second‐generation cryoballoon ablation. (30th September 2019) - Terasawa, Muryo
Abstract: Introduction: The right inferior pulmonary vein (RIPV) accounts as the most frequently reconnected vein after pulmonary vein isolation using second‐generation cryoballoon ablation (CB‐A). Our objective was to assess anatomic predictors of late RIPV reconnection based on preprocedural computed tomography scan. Methods: Patients with a repeat procedure for atrial tachyarrhythmia recurrence after index CB‐A procedure were included. A total of 129 RIPVs were evaluated for ostial diameters, ostial area, and branching pattern. Interior angle between RIPV and horizontal line in the frontal/transversal plane was used to measure the RIPV orientation: RIPV frontal/transversal angle, respectively. In addition, interior angle between RIPV and the line perpendicular on the septal intersection line at the level of the fossa ovalis, estimated as trans‐septal (TS) puncture site, was measured in the frontal/transversal view: RIPV‐TS frontal/transversal angle, respectively. Results: Late vein reconnection was present in 36/129 RIPVs (28%). Warmer balloon nadir temperature ( P = .01), more inferior ( P < .001) and posterior ( P < .01) RIPV orientation (ie, more positive RIPV frontal and RIPV transversal angle, respectively), and sharper RIPV‐TS frontal angle ( P < .001) were associated with late RIPV reconnection on univariate analysis. Independent variables after multivariate analysis were nadir temperature (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03‐1.23; P = .013) and RIPV frontal angle (OR, 1.13, CI, 1.07‐1.19; P < .001). Conclusion: Frontal RIPV orientation could significantly predict late RIPV electrical reconnection after CB‐A. Therefore, preprocedural anatomic assessment of the RIPV might be useful to plan the correct ablation strategy.