Objective To analyze factors that affect the difficulty of ablation of right inferior pulmonary vein(RIPV)in atrial fibrillation(AF)using second-generation cryoballoon ablation(CB2).Methods A total of 234 patients with atrial fibrillation who were first treated with CB2 ablation from June 2019 to March 2022 in TEDA International Cardiovascular Hospital were retrospectively analyzed.All patients had completed CT angiography(CTA)of the left atrium before ablation,Anatomical characteristics including PV max diameter,PV minimum diameter,PV ovality,PV angle(downward,backward),interval length of P Vs,PV height,and early branchings were collected.A difficult PV was defined as the requirement for three or more than three times cooling applications or touch-up ablation to achieve pulmonary vein isolation(PVI).Results A total of 234 patients[(62.8±8.1)years,87(37.2％)females,164(70.1％)paroxysmal AF]were divided into two groups,56 in the difficult group,and 178 in the easy group.There was no significant difference in baseline data between the two groups(all P＞0.05).PVI was achieved in all PVs.Nadir temperature during ablation[(-48.0±6.2)℃ vs.(-44.6±6.5)℃,P＜0.001]and the real-time recording rate of pulmonary vein potential(PVP)(49.4％vs.33.9％,P=0.042)were better in the easy group than the difficult group.In the difficult group,the proportion of early cases(cases in 2019)was higher(46.4％vs.19.7％,P＜0.001);PV downward angle was[(59.5±12.3)° vs.(65.1±14.6)°,P=0.005]in easy group and difficult group respectively.There was no significant difference between the two groups in terms of PV diameter,PV ovality,PV backward angle(downward),interval length of PVs,PV height,and early branchings,etc.(all P＞0.05).Logistic regression analysis conducted by incorporating the above anatomical factors and ablation period(cases in 2019)showed that downward angulation and early cases were independent risk factors affecting ablation difficulty(OR 0.968,95％CI 0.943～0.993,P=0.013;OR 0.285,95％CI 0.143～0.565,P=0.001).The receiver operating characteristic curve showed that the area under curve for predicting the difficulty of RIPV occlusion was 0.745,with 95％CI of 0.668 to 0.822,P＜0.001.The optimal cutoff value was 63.5°,sensitivity was 67.9％,and specificity was 71.9％.Conclusions Downward angulation of RIPV had significant effect on the difficulty of ablation,while proficiency of the operator was an important factor.
维普
万方数据