INTRODUCTION: The right inferior pulmonary vein (RIPV) accounts as the most frequently reconnected vein after PV isolation using second generation cryoballoon ablation (CB-A). Our objective was to assess anatomic predictors of late RIPV reconnection based on preprocedural computed tomography (CT) 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 = 0.01), more inferior (P < 0.001) and posterior (P < 0.01) RIPV orientation (i.e. more positive RIPV frontal and RIPV transversal angle, respectively), and sharper RIPV-TS frontal angle (P < 0.001) 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 = 0.013) and RIPV frontal angle (OR 1.13, CI 1.07-1.19, P < 0.001).

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. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)2294-2301
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Issue number11
Early online date19 Sep 2019
Publication statusPublished - Nov 2019

    Research areas

  • atrial fibrillation, pulmonary vein anatomy, right inferior pulmonary vein reconnection, second generation cryoballoon ablation

ID: 47479962