Pulmonary Vein Remodeling Between Atrial Fibrillation Subtypes: A Matched Comparison Cardiac Computed Tomography-Based Study Between Patients With Paroxysmal and Persistent Atrial Fibrillation.

Although pulmonary vein (PV) isolation (PVI) is the cornerstone for atrial fibrillation (AF) ablation, no data exist comparing PV anatomy between AF subtypes directly. We aimed to compare PV anatomic characteristics between paroxysmal (PAF) and persistent AF (PeAF) in a matched population using cardiac computed tomography (CCT). Fifty-eight PeAF patients (with CCT prior first AF ablation procedure, absence of valvular disease/previous cardiac intervention), and 58 age-, sex-, body surface area-matched PAF patients were evaluated for left atrial (LA) and PV anatomy: ostial area, ovality index (OVI), transverse/frontal angles. In PeAF vs PAF group, beside higher LA volume index (LAVI), PVs' ostial areas were significantly larger (between 64 - 101 mm ² , P < 0.001 for all PVs; remaining valid after LAVI adjustment for left superior [LS], left inferior [LI], and right inferior [RI]PV); left PVs were less oval (0.7 - 0.11 OVI decrease, P =0.039 for LSPV; P = 0.012 for LIPV); LSPV (P = 0.019), LIPV (P < 0.001), RIPV (P = 0.029) were more posteriorly directed; whereas LSPV (P = 0.002), and right superior PV (P = 0.043) were more superiorly directed. Incidence of anatomic variations or early branching was not different. This study showed significant anatomical PV differences between patients with PeAF and PAF, in terms of PV orientation, ostial size and ovality. Anticipating such anatomical differences may aid in choosing the adequate catheter design and technology for PeAF ablation.
Competing Interests: Declaration of Competing Interest Dr. de Asmundis reports speaker fees for Medtronic, Biotronik, Biosense Webster, Abbott, and Boston Scientific; teaching honoraria from Medtronic, Biotronik, Abbott, and Boston Scientific; proctoring honoraria from Medtronic, Abbott, and Biotronik. Dr. Chierchia reports speaker fees for Medtronic, Biotronik, Biosense Webster, and Abbott; teaching honoraria from Medtronic and Biotronik; proctoring honoraria from Medtronic. Dr. Brugada reports consulting fees and speaker honoraria from Medtronic. Dr. Miraglia has received an educational grant from the “Foundation Enrico and Enrica Sovena.” The remaining authors have no competing interests to declare.
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