Impact of Pulmonary Vein Anatomy on Outcomes in Patients Undergoing Cryoballoon Ablation for Atrial Fibrillation

Effective pulmonary vein isolation (PVI) using cryoballoon (CB) ablation relies on adequate pulmonary vein (PV) occlusion, which may be influenced by PV and left atrial (LA) anatomy.

To evaluate the impact of PV and LA anatomy, assessed by cardiac computed tomography (CT), on long-term outcomes and complications following CB ablation for AF.

This retrospective study included 416 patients (54.8% female, mean age 57.5 ± 12.4 years) who underwent CB ablation for symptomatic AF. Paroxysmal AF was present in 87% and persistent AF in 13% of patients. Arctic Front Advance or Arctic Front Advance PRO catheters were used. All patients had preprocedural cardiac CT. AF recurrence and procedural complications were evaluated over a median follow-up of 46.5 months (range: 6-116).

Freedom from AF was observed in 73.1% of patients during follow-up. Multivariable Cox regression analysis revealed that the maximum diameter of right superior PV (RSPV) (HR: 1.076, 95% CI: 1.003-1.154, p = 0.040) and the frontal angle of the left superior PV (LSPV) (HR:0.984, 95% CI: 0.968-0.999, p = 0.048) were independent predictors of recurrence. Independent predictors of phrenic nerve injury included the frontal angle of the RSPV (OR: 1.072, 95% CI: 1.020-1.126, p = 0.006) and the distance between the RSPV and the right phrenic nerve bundle (OR: 0.327, 95% CI: 0.188-0.579, p < 0.001).

Specific PV anatomical features influence AF recurrence and PNI after CB ablation. Preprocedural cardiac CT may help tailor ablation strategies and optimize patient outcomes.