title: Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation.
abstract: BACKGROUND
  Previous studies reported on the impact of pulmonary vein orientation on pulmonary vein isolation (PVI) outcome in atrial fibrillation patients undergoing laser balloon PVI and point-by-point radiofrequency ablation.
  
  
  OBJECTIVE
  Demonstrate the association between pulmonary vein orientation and PVI outcome after multi-electrode radiofrequency ablation.
  
  
  METHODS
  120 patients undergoing PVI with a circular MER catheter were included. A left atrial ECG-triggered CT was performed in all patients prior to PVI. The orientation of all pulmonary veins at the insertion into the left atrium was measured in the axial and coronal planes. pulmonary veins were classified as having a ventral/dorsal and caudal/cranial orientation depending on the pulmonary vein trunk angle as compared to the median angle.
  
  
  RESULTS
  Mean age was 56 years, arrhythmia-free survival after a median follow-up of 20 months was 54.2%. Left upper pulmonary vein orientation within the coronal plane was associated with arrhythmia-free survival, ranging from 58% with a cranial pulmonary vein orientation to 21% with a caudal orientation (p = 0.003). Similarly, arrhythmia-free survival was 50% in patients with a caudal orientation and 33% in patients with a cranial orientation of the left lower pulmonary vein in the coronal plane (p = 0.036). Pulmonary vein orientation in the axial plane and orientation of the right-sided pulmonary veins were not associated with arrhythmia-free survival. Multivariable analysis showed an independent association between both left upper (hazard ratio 2.8, p = 0.001) and left lower (hazard ratio 0.490, p = 0.034) pulmonary vein orientation and arrhythmia-free survival.
  
  
  CONCLUSIONS
  In MER ablation, orientation of the left upper and caudalpulmonary veins in the coronal plane were independently associated with arrhythmia-free survival after multi-electrode PVI.
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Buist
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Gal
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Jaap Jan J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Peter Paul Hm
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
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, Zwolle, The Netherlands. Electronic address: v.r.c.derks@isala.nl.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D055424:Cardiac-Gated Imaging Techniques; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D018572:Disease-Free Survival; D004562:Electrocardiography; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010690:Phlebography / Q000379:methods; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Multi-electrode ablation; PVAC; Pulmonary vein anatomy; Pulmonary vein isolation; Pulmonary vein orientation