Pulmonary veins branching pattern, assessed by magnetic resonance, does not affect transcatheter atrial fibrillation ablation outcome

Matteo Anselmino, Marco Scaglione, Alessandro Blandino, Serena Beninati, Domenico Caponi, Carlo Boffano, Antonio Montefusco, Federico Cesarani, Fiorenzo Gaita

Research output: Contribution to journalArticle

Abstract

Aim - The aim of the present study is to provide, in a large cohort of patients, a description of the left atrium (LA) and pulmonary veins (PV) anatomy in relation to ablation outcome. Background - The role of LA imaging, assessed before transcatheter ablation of atrial fibrillation (AF), is unknown. Methods - 330. patients referred for transcatheter ablation of AF (paroxysmal 62.7%; persistent 25.5%; long-standing 11.8%) underwent contrast-enhanced magnetic resonance imaging (MRI) before the procedure. Transcatheter ablation was performed aiming to AF interruption and/or absence of inducibility. Patients were followed clinically, by ECG, and 24-hour Holter ECG at 1-3-6-12-18-24 months. Results - The MRI preceding the procedure depicted a typical PV branching pattern, two left and two right, in 130 (39.4%) patients; 117 (35.4%) presented common left trunk (short and long) and 75 (22.7%) at least one accessory PV. Mean atrial volume was 142.0 ± 48.5 ml. The ablation procedure resulted successful, after 15.6 ± 7.2 months follow-up, in 174 (52.7%) patients. PV branching pattern did not relate (P = 0.304) to ablation outcome. A multiple Cox proportional hazard model, adjusted for potential confounders, proved that only LA volume was independently related to ablation outcome (HR 1.007, 95% CI 1.003-1.011; P = 0.001). A LA cut-off volume of 135 ml emerged as a significant predictor of ablation failure (ROC curve area 0.651, 95% CI 0.591-0.710; P <0.001). Conclusions - Less than half of the patients referred for transcatheter AF ablation present a typical PV branching pattern; the PV branching pattern, however, does not affect ablation outcome. LA volume strongly predicts AF ablation outcome.

Original languageEnglish
Pages (from-to)665-674
Number of pages10
JournalActa Cardiologica
Volume65
Issue number6
DOIs
Publication statusPublished - 2010

Keywords

  • Ablation
  • Anatomy
  • Atrial fibrillation
  • Left atrium
  • Magnetic resonance imaging
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Anselmino, M., Scaglione, M., Blandino, A., Beninati, S., Caponi, D., Boffano, C., Montefusco, A., Cesarani, F., & Gaita, F. (2010). Pulmonary veins branching pattern, assessed by magnetic resonance, does not affect transcatheter atrial fibrillation ablation outcome. Acta Cardiologica, 65(6), 665-674. https://doi.org/10.2143/AC.65.6.2059864