title: Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation.
abstract: OBJECTIVE
  Multidetector computed tomography (MDCT) is frequently used to guide circumferential pulmonary vein ablation (PVA) for treatment of atrial fibrillation (AF) as it offers accurate visualization of the left atrial (LA) and pulmonary vein (PV) anatomy. This study aimed to identify if PV anatomy is associated with outcomes following PVA using remote magnetic navigation (RMN).
  
  
  RESULTS
  We analysed data from 138 consecutive patients and 146 ablation procedures referred for PVA due to drug-refractory symptomatic AF (age 63 ± 11 years; 57% men; 69% paroxysmal AF). The RMN using the stereotaxis system and open-irrigated 3.5 mm ablation catheters was used in all procedures. Prior to PVA, all patients underwent electrocardiogram-gated 64-MDCT for assessment of LA dimensions, PV anatomy, and electro-anatomical image integration during the procedure. Regular PV anatomy was found in 68%, a common left PV ostium was detected in 26%, and variant anatomy of the right PVs was detected in 6%. After a mean follow-up of 337 ± 102 days, 63% of the patients maintained sinus rhythm after the initial ablation, and 83% when including repeat PVA. Although acutely successful PV isolation did not differ between anatomical subgroups (regular 3.5 ± 0.8 vs. variant 3.2 ± 1.3; P = 0.31), AF recurrence was significantly higher in patients with non-regular PV anatomy (P = 0.04, hazard ratio 1.72). Pulmonary vein anatomy did not influence complication rates.
  
  
  CONCLUSIONS
  Pulmonary vein anatomy assessed by MDCT is a good predictor of AF recurrence after PVA using RMN.
authors.affiliation: Department of Cardiology and Pneumology, Heart Center, Section Clinical Electrophysiology, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. csohns@med.uni-goettingen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.forename: Jan M
authors.initials: JM
authors.lastname: Sohns
authors.forename: Leonard
authors.initials: L
authors.lastname: Bergau
authors.forename: Samuel
authors.initials: S
authors.lastname: Sossalla
authors.forename: Dirk
authors.initials: D
authors.lastname: Vollmann
authors.forename: Lars
authors.initials: L
authors.lastname: Lüthje
authors.forename: Wieland
authors.initials: W
authors.lastname: Staab
authors.forename: Marc
authors.initials: M
authors.lastname: Dorenkamp
authors.forename: James L
authors.initials: JL
authors.lastname: Harrison
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
authors.forename: Joachim
authors.initials: J
authors.lastname: Lotz
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008280:Magnetics / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D016896:Treatment Outcome
keywords: Atrial fibrillation; Multidetector computed tomography; Pulmonary vein ablation; Pulmonary vein anatomy