title: Association between pulmonary vein orientation and atrial fibrillation-free survival in patients undergoing endoscopic laser balloon ablation.
abstract: OBJECTIVE
  Obtaining optimal pulmonary vein (PV) occlusion with the endoscopic laser balloon ablation system (EAS) can be difficult, hypothetically influenced by PV geometry. The aim of this study was to determine the impact of PV orientation on atrial fibrillation (AF)-free survival after PV isolation (PVI) using the EAS.
  
  
  RESULTS
  Forty-three patients undergoing a single EAS PVI were included. Left atrial electrocardiogram -triggered computed tomography was performed in all patients prior to PVI. Of all four PVs, the orientation at the insertion in the left atrium was measured in both the transverse and frontal plane and assigned to one of the four orientation groups: ventral-caudal, dorsal-caudal, ventral-cranial, and dorsal-cranial. Mean age was 56 years; 86% had paroxysmal AF. Overall, AF-free survival after a median follow-up of 18.2 months was 51.2%. AF-free survival varied between 21 and 88% depending on left upper PV orientation (P = 0.045). Furthermore, AF-free survival varied between 21 and 86% depending on left lower PV orientation (P = 0.010) and AF-free survival varied between 29 and 88% depending on right lower PV orientation (P = 0.053). No association was found between right upper PV orientation and AF-free survival after EAS PVI (P = 0.794). In multivariate analysis, only left lower PV orientation was associated with AF-free survival [hazards ratio (HR) 10.4, P = 0.019].
  
  
  CONCLUSIONS
  PV orientation is associated with AF-free survival after EAS PVI. PV orientation assessment may be useful for selecting the most suitable patients for EAS PVI.
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Gal
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Joris F W
authors.initials: JF
authors.lastname: Ooms
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Jaap Jan J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands.
authors.forename: Peter Paul H M
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Department of Nuclear Medicine, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Piet L
authors.initials: PL
authors.lastname: Jager
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, Zwolle, The Netherlands v.r.c.derks@isala.nl a.elvan@isala.nl.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000033:anatomy & histology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: atrial fibrillation; laser balloon ablation system; pulmonary vein anatomy; pulmonary vein isolation