title: Particular Morphology of Inferior Pulmonary Veins and Difficulty of Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation.
abstract: The CRYO-Japan PMS study indicated that cryoballoon ablation (Cryo-Abl) has a lower acute success rate of pulmonary vein isolation (PVI) for the right and left inferior PVs (RIPV and LIPV, respectively) than for the superior PVs. This study aimed to determine if the orientation and position of the inferior PVs are related to the difficulty of acute success of PVI.
  
  
  
  We investigated 30 consecutive patients who underwent Cryo-Abl. A "difficult PV" was defined as the requirement for >2 cooling applications and/or touch-up ablation to achieve PVI. We measured the ventral angle between the vertical line and the direction of each PV trunk (PV angle) on the transverse plane of enhanced CT images. PV position was defined as the difference in the levels between the bottom of the RIPVs and the non-coronary cusp of the aorta. PV angle <105° and PV position <1.250 mm were independent factors of difficult RIPV isolation (PV angle: odds ratio (OR)=23.80, confidence interval (CI) -3.15528 to -0.53622, P=0.002; PV position: OR=12.14, CI -2.77301 to -0.23160, P=0.014). PV position <16.875 mm was also related to the difficulty of LIPV isolation (OR=5.78, CI -1.77095 to -0.09474, P=0.027).
  
  
  
  RIPV with ventral orientation may require difficult maneuvers to advance an ablation system towards it. Low take-off of the inferior PVs may cause non-coaxial configuration of balloon catheters towards the direction of these veins.
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Ryobun
authors.initials: R
authors.lastname: Yasuoka
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kurita
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Kotake
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashiguchi
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Motoki
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kobuke
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwanaga
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods; D001281:Atrial Fibrillation / Q000601:surgery; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: Anatomy; Atrial fibrillation; Cryoballoon ablation; Pulmonary veins