Association of the left common ostium with clinical outcome after pulmonary vein isolation in atrial fibrillation

Rafael M Ronsoni; Tiago L Silvestrini; Vidal Essebag; Renato D Lopes; Marco Aurélio Lumertz Saffi; Tiago Luiz Luz Leiria

doi:10.1016/j.ipej.2020.11.020

Association of the left common ostium with clinical outcome after pulmonary vein isolation in atrial fibrillation

Indian Pacing Electrophysiol J. 2021 Mar-Apr;21(2):95-100. doi: 10.1016/j.ipej.2020.11.020. Epub 2020 Nov 30.

Authors

Rafael M Ronsoni¹, Tiago L Silvestrini², Vidal Essebag³, Renato D Lopes⁴, Marco Aurélio Lumertz Saffi⁵, Tiago Luiz Luz Leiria⁶

Affiliations

¹ Instituto de Ritmologia Cardíaca, Joinville, Santa Catarina, Brazil; Universidade da Região de Joinville, Joinville, Santa Catarina, Brazil. Electronic address: rafael@institutorit.com.br.
² Instituto de Ritmologia Cardíaca, Joinville, Santa Catarina, Brazil.
³ Electrophysiology Department, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada.
⁴ Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
⁵ Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
⁶ Programa de Pós-Graduação em Ciências da Saúde, Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.

Abstract

Introduction: Electrical pulmonary vein isolation (PVI) is used for the invasive treatment of atrial fibrillation (AF). However, despite the procedure's technical evolution, the rate of AF recurrence due to electrical reconnection of the PVs is high. The aims of this study was to assess the influence of left common pulmonary venous ostium (LCO) on clinical outcomes following PVI.

Methods: Retrospective cohort of 254 patients who underwent the first procedure of PVI from the years 2013-2018 was assessed. Patients with persistent AF of long duration and extra-pulmonary focus associated with triggers for arrhythmia were excluded. Patients were stratified into two groups according to the presence of a LCO and received follow up for atrial tachyarrhythmia-free survival. The mean follow-up period was 28 ± 1.73 months.

Results: The majority were men (68.5%), with a mean age of 54 ± 12 years. With respect to the atrial anatomy, LCO occurred in 23.6% of cases after pulmonary venous angiotomography. The arrhythmia-free survival rate was 79.5% in the follow-up period. The Cox regression model was utilized and the adjusted hazard ratio for LCO was 0.36 (95% CI 0.15-0.87; p = 0.02) in terms of age, body mass index, left atrium diameter, bi-directional blocking of the cavotricuspid isthmus, persistent AF, left ventricular ejection fraction adjusted model.

Conclusion: Anatomic abnormality with the presence of the LCO is present in a quarter of patients undergoing AF ablation, which is associated with a lower rate of arrhythmia recurrence in our population.

Keywords: Ablation; Anatomy; Atrial fibrillation; Pulmonary vein; Pulmonary vein isolation.