Abstract 11654: Association of Pulmonary Vein Diameters With Atrial Fibrillation Recurrence Following Ablation
Background: Pulmonary vein (PV) isolation is commonly used for treatment of drug-refractory symptomatic atrial fibrillation (AF). Previous studies have reported contradictory results regarding the association of PV structure and AF recurrence following ablation. We sought to examine the association of PV diameter with AF recurrence following ablation.
Methods: We conducted a retrospective cohort study of 132 patients with AF that had undergone initial PV isolation. Cardiac magnetic resonance angiography was performed prior to ablation, and pulmonary vein and left atrial dimensions were measured. In the presence of a left common PV trunk, the diameter of the superior vein branch was measured after the ostium. Recurrence of AF was documented using scheduled (6 and 12 months) and symptom-prompted electrocardiography.
Results: The average age was 59.7±9.8 years. Of all patients 78.8% were male, 88.6% were Caucasian, and 45.5% had persistent AF. Atrial fibrillation recurrence was noted in 48 (36%) of patients at 1 year. Due to significant co-linearity among PV diameters within the same individual, the left superior PV (LSPV) diameter was used as a surrogate for all veins. In a multivariable Cox proportional hazards model adjusting for left atrial volume, AF persistence, age, and gender, LSPV diameter > 90th percentile (22 mm) was independently associated with AF recurrence (Figure, Hazard Ratio 1.89 ± 0.57, p=0.035).
Conclusion: Increased PV diameter is associated with AF recurrence following PV isolation. Tools to improve the efficiency and permanence of electrical isolation for large diameter PVs will likely improve procedural efficacy.
Figure. The hazard ratio plot demonstrates that as the LSPV diameter increases, the hazard ratio of AF recurrence after PVI increases.
Author Disclosures: Y. Mints: None. E. Gucuk Ipek: None. M. Habibi: None. J. Chrispin: None. J.E. Marine: None. J. Rickard: Speakers Bureau; Modest; St. Jude, speaker. D. Spragg: None. S. Zimmerman: None. H. Calkins: Research Grant; Modest; St Jude Medical. Consultant/Advisory Board; Modest; Medtronic, St Jude Medical. S. Nazarian: Research Grant; Modest; NIH, Biosense Webster. Consultant/Advisory Board; Modest; Biosense Webster, Medtronic, CardioSolv.
- © 2015 by American Heart Association, Inc.