Atrial Fibrillation Cryoballoon Ablation in Patients with a Common Pulmonary Vein Trunk

Objective: we aimed to assess the efficacy and safety of pulmonary vein (PV) cryoballoon ablation (CBA) in patients with a common trunk of the pulmonary veins (PVCT).Materials and methods: We performed a retrospective analysis of 596 primary PV CBA procedures using the second-generation cryoballoon (CB) Arctic Front Advance (28 mm). PV anatomy was visualized using direct LA angiography during high-frequency right ventricular pacing. We included forty-nine patients in whom a PVCT was identified. The one-step and sequential ablation approaches with simultaneous recording of biophysical and electrophysiological parameters were used for PVCT isolation. During CBA in the right PVs, high-output (2000 ms, 25 mA) pacing of the right phrenic nerve was performed via a electrode placed in the superior vena cava, and amplitude of diaphragm movement was monitored. In the case of impairment/loss of the diaphragm contraction ablation was immediately stopped.Results: 91.1% (543) patients had the normal drainage of PV. In 4 patients (0.67%), an additional right pulmonary vein was identified. The prevalence of PVCT was 8.2% (49 pts): a left common trunk (LCT) was observed in 43 patients (87.7%), a right common trunk (RCT) - in 6 patients (12.2%). Acute efficacy of PVCT isolation was 95.9% (47/79): in LCT - 95.3%, in RCT - 100%. The feasibility of the one-step antral isolation was 59.1% (n=29). During a median follow up of 12 (3-20) months, the clinical success rate of the procedure was 69.4%. A comparative analysis showed no significant difference between common trunk ablation approaches and clinical efficacy (p=0.346).Conclusion: CBA has been shown effective and safe for symptomatic AF patients with PVCT. The simultaneous and sequential ablation approaches can be performed with comparable efficacy.