ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1496922
CT-angiography derived 3-dimensional pulmonary vein topography is related to outcome after cryoballoon ablation
Provisionally accepted
Martin Saal1
Annika Esser1Torsten Becker1
Florian Stöckigt2Yazan Mohsen2Marc Horlitz2Michael Haude1
Dennis Rottländer2,3*- 1Rheinlandklinikum Neuss, Neuss, Germany
- 2Krankenhaus Porz am Rhein, Cologne, Germany
- 3Witten/Herdecke University, Witten, North Rhine-Westphalia, Germany
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Background: 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.Methods: We aimed to analyze the impact of anatomical and topographic PV parameters on procedural outcome of cryoballoon PVI using a retrospective analysis of 106 patients with paroxysmal AF and preprocedural CTA. Results: 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 α (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 β (PV orifice-PV course) was increased and intraatrial angle γ (septum-PV course) was decreased in the inferior PVs of the PVI failure group.Patient selection using CTA prior cryoballoon ablation might influence procedural success of cryoballoon PVI. While PV anatomy in regard to vein size and shape was not associated with procedural outcome, septum, orifice and intraatrial angulation were related to procedural success.
Keywords: Atrial Fibrillation, Cryoballoon, Pulmonary vein isolation, Computer tomography angiography, Angulation, pulmonary vein anatomy
Received: 15 Sep 2024; Accepted: 17 Apr 2025.
Copyright: © 2025 Saal, Esser, Becker, Stöckigt, Mohsen, Horlitz, Haude and Rottländer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dennis Rottländer, Krankenhaus Porz am Rhein, Cologne, Germany
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