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Peer-reviewedCC BYJournal of arrhythmia

Pulmonary Vein Anatomy, Cooling Kinetics, and Recurrence After Cryoballoon Ablation for Atrial Fibrillation

  • Kuo‐Ming Yang1,2,3
  • Hsiang‐Chiang Hsiao1,4
  • Tung‐Chen Yeh1
  • Chun‐Wang Chiou1,4
  • Jeng‐Fung Hung5
  • Cheng‐Hung Chiang1,4,5,6
6 affiliations
  1. 1Cardiovascular Medical Center Kaohsiung Veterans General Hospital Kaohsiung Taiwan
  2. 2Department of Critical Care Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
  3. 3Department of Optometry Shu‐Zen Junior College of Medicine and Management Kaohsiung Taiwan
  4. 4School of Medicine, College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
  5. 5Institute of Science Education and Environmental Education National Kaohsiung Normal University Kaohsiung Taiwan
  6. 6Department of Physical Therapy Shu‐Zen Junior College of Medicine and Management Kaohsiung Taiwan
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Abstract

Background: Cryoballoon pulmonary vein isolation depends on balloon‐to‐ostium contact. We assessed whether computed tomography‐derived pulmonary vein ostial area (OA) and ovality index (OI) were associated with cooling after accounting for pulmonary vein (PV) branch and within‐patient clustering, and whether PV anatomy was associated with recurrence.

Methods: We retrospectively studied 120 patients with symptomatic atrial fibrillation undergoing second‐generation cryoballoon ablation. Vein‐level associations with nadir temperature, 1 min temperature, and time to isolation were assessed using linear mixed‐effects models with a patient random intercept and PV branch as a fixed effect; generalized estimating equations served as sensitivity analyses. Given 23 post‐blanking recurrences, logistic models were limited to left atrial volume index (LAVI) and one clinically selected covariate, with Firth‐penalized regression as a sensitivity analysis.

Results: All patients achieved acute PV isolation. Larger OA was associated with lower nadir temperature (β = −0.583°C per 50 mm2; 95% CI, −0.910 to −0.257; p < 0.001) and 1 min temperature (β = −0.441°C per 50 mm2; 95% CI, −0.764 to −0.118; p = 0.008) after branch and clustering adjustment. OI was not associated with either temperature outcome. Twenty‐three patients (19.2%) developed recurrent atrial arrhythmia. LAVI was associated with recurrence (adjusted OR, 1.659 per 10 mL/m2; 95% CI, 1.250–2.201; p < 0.001), whereas persistent AF was not.

Conclusions: OA showed a modest association with cryoballoon temperatures but should not be used as a stand‐alone prognostic marker. LAVI remained associated with recurrence in parsimonious patient‐level analyses.

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Cite

BibTeXRIS
BibTeX
@article{yang2026pulmonary,
  title = {{Pulmonary Vein Anatomy, Cooling Kinetics, and Recurrence After Cryoballoon Ablation for Atrial Fibrillation}},
  author = {Kuo‐Ming Yang and Hsiang‐Chiang Hsiao and Tung‐Chen Yeh and Chun‐Wang Chiou and Jeng‐Fung Hung and Cheng‐Hung Chiang},
  journal = {Journal of arrhythmia},
  year = {2026},
  month = nov,
  doi = {10.1002/joa3.70511},
  url = {https://europepmc.org/article/PMC/PMC13728550},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Pulmonary Vein Anatomy, Cooling Kinetics, and Recurrence After Cryoballoon Ablation for Atrial Fibrillation
AU  - Kuo‐Ming Yang
AU  - Hsiang‐Chiang Hsiao
AU  - Tung‐Chen Yeh
AU  - Chun‐Wang Chiou
AU  - Jeng‐Fung Hung
AU  - Cheng‐Hung Chiang
PY  - 2026
DA  - 2026/11/02
JO  - Journal of arrhythmia
DO  - 10.1002/joa3.70511
UR  - https://europepmc.org/article/PMC/PMC13728550
AB  - Background: Cryoballoon pulmonary vein isolation depends on balloon‐to‐ostium contact. We assessed whether computed tomography‐derived pulmonary vein ostial area (OA) and ovality index (OI) were associated with cooling after accounting for pulmonary vein (PV) branch and within‐patient clustering, and whether PV anatomy was associated with recurrence.  Methods: We retrospectively studied 120 patients with symptomatic atrial fibrillation undergoing second‐generation cryoballoon ablation. Vein‐level associations with nadir temperature, 1 min temperature, and time to isolation were assessed using linear mixed‐effects models with a patient random intercept and PV branch as a fixed effect; generalized estimating equations served as sensitivity analyses. Given 23 post‐blanking recurrences, logistic models were limited to left atrial volume index (LAVI) and one clinically selected covariate, with Firth‐penalized regression as a sensitivity analysis.  Results: All patients achieved acute PV isolation. Larger OA was associated with lower nadir temperature (β = −0.583°C per 50 mm2; 95% CI, −0.910 to −0.257; p < 0.001) and 1 min temperature (β = −0.441°C per 50 mm2; 95% CI, −0.764 to −0.118; p = 0.008) after branch and clustering adjustment. OI was not associated with either temperature outcome. Twenty‐three patients (19.2%) developed recurrent atrial arrhythmia. LAVI was associated with recurrence (adjusted OR, 1.659 per 10 mL/m2; 95% CI, 1.250–2.201; p < 0.001), whereas persistent AF was not.  Conclusions: OA showed a modest association with cryoballoon temperatures but should not be used as a stand‐alone prognostic marker. LAVI remained associated with recurrence in parsimonious patient‐level analyses.
SN  - 1880-4276
SN  - 1883-2148
ER  -