Impact of Pulmonary Vein Anatomy on Outcomes in Patients Undergoing Cryoballoon Ablation for Atrial Fibrillation

BACKGROUND: Effective pulmonary vein isolation (PVI) using cryoballoon (CB) ablation relies on adequate pulmonary vein (PV) occlusion, which may be influenced by PV and left atrial (LA) anatomy. OBJECTIVES: To evaluate the impact of PV and LA anatomy, assessed by cardiac computed tomography (CT), on long-term outcomes and complications following CB ablation for AF. METHODS: This retrospective study included 416 patients (54.8% female, mean age 57.5 ± 12.4 years) who underwent CB ablation for symptomatic AF. Paroxysmal AF was present in 87% and persistent AF in 13% of patients. Arctic Front Advance or Arctic Front Advance PRO catheters were used. All patients had preprocedural cardiac CT. AF recurrence and procedural complications were evaluated over a median follow-up of 46.5 months (range: 6-116). RESULTS: Freedom from AF was observed in 73.1% of patients during follow-up. Multivariable Cox regression analysis revealed that the maximum diameter of right superior PV (RSPV) (HR: 1.076, 95% CI: 1.003-1.154, p = 0.040) and the frontal angle of the left superior PV (LSPV) (HR:0.984, 95% CI: 0.968-0.999, p = 0.048) were independent predictors of recurrence. Independent predictors of phrenic nerve injury included the frontal angle of the RSPV (OR: 1.072, 95% CI: 1.020-1.126, p = 0.006) and the distance between the RSPV and the right phrenic nerve bundle (OR: 0.327, 95% CI: 0.188-0.579, p < 0.001). CONCLUSION: Specific PV anatomical features influence AF recurrence and PNI after CB ablation. Preprocedural cardiac CT may help tailor ablation strategies and optimize patient outcomes.