Saal Martin, Esser Annika, Becker Torsten, Stöckigt Florian, Mohsen Yazan, Horlitz Marc, Haude Michael, Rottländer Dennis
Department of Cardiology, Rheinland Klinikum Neuss, Neuss, Germany.
Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany.
Front Cardiovasc Med. 2025 May 8;12:1496922. doi: 10.3389/fcvm.2025.1496922. eCollection 2025.
Following cryoballoon ablation, 20%-30% of the patients show recurrent atrial fibrillation (AF) in long-term follow-up as a consequence of incomplete circumferential ablation lines. Patient selection using computer tomography angiography (CTA)-derived parameters might be feasible to assign patients for cryoballoon ablation according to pulmonary vein (PV) anatomy and topography.
We aimed to analyze the impact of anatomical and topographic PV parameters on the procedural outcome of cryoballoon PVI using a retrospective analysis of 106 patients with paroxysmal AF and preprocedural CTA.
Clinical follow-up of the study cohort revealed 78 patients (73.6%, PVI success group) without and 28 patients (26.4%, PVI failure group) with recurrent AF 12 months after cryoablation. Anatomical measurements such as PV diameter, PV area, PV perimeter, or PV eccentricity were not associated with procedural success. The number of occlusion attempts in the right inferior PV was significantly higher in the PVI failure group indicating a technical more complex balloon occlusion. The septum angle (septum-PV) was significantly lower in the superior PVs of the PVI failure group indicating a direct relation of transseptal puncture site to procedural success. Furthermore, orifice angle (PV orifice-PV course) was increased and intra-atrial angle (septum-PV course) was decreased in the inferior PVs of the PVI failure group.
Patient selection using CTA prior to cryoballoon ablation might influence the procedural success of cryoballoon PVI. While PV anatomy in regard to vein size and shape was not associated with procedural outcome, septum, orifice, and intra-atrial angulation were related to procedural success.
冷冻球囊消融术后，20%-30%的患者在长期随访中因环周消融线不完整而出现复发性心房颤动（AF）。利用计算机断层血管造影（CTA）得出的参数进行患者选择，根据肺静脉（PV）的解剖结构和形态为冷冻球囊消融分配患者可能是可行的。
我们旨在通过对106例阵发性AF患者和术前CTA进行回顾性分析，来分析解剖学和形态学PV参数对冷冻球囊肺静脉隔离术（PVI）手术结果的影响。
对研究队列的临床随访显示，78例患者（73.6%，PVI成功组）在冷冻消融术后12个月无复发性AF，28例患者（26.4%，PVI失败组）出现复发性AF。PV直径、PV面积、PV周长或PV偏心率等解剖学测量与手术成功无关。PVI失败组右下PV的封堵尝试次数显著更高，表明球囊封堵技术上更为复杂。PVI失败组上PV的间隔角（间隔-PV）显著更低，表明经间隔穿刺部位与手术成功直接相关。此外，PVI失败组下PV的开口角（PV开口-PV走行）增加，房内角（间隔-PV走行）减小。
冷冻球囊消融术前使用CTA进行患者选择可能会影响冷冻球囊PVI的手术成功率。虽然PV在静脉大小和形状方面的解剖结构与手术结果无关，但间隔、开口和房内角与手术成功有关。
