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Master Thesis

Anatomie atypique des veines pulmonaires droites et cryo-ablation de fibrillation atriale

Abstract : Background: Cryoballoon (CB) ablation is widely used for pulmonary vein (PV) isolation in patients with atrial fibrillation (AF). There are no data regarding clinical efficacy of CB ablation in patients with atypical right PV anatomy. We aimed to evaluate the impact of right PV anatomy on safety and efficacy of CB ablation. Methods: Patients referred for CB ablation of paroxysmal AF were prospectively enrolled. A left atrial computed tomography was performed prior to CB ablation to determine whether right PV anatomy was “normal” or “atypical”. For patients with atypical anatomy, CB ablation was only performed for right superior (RSPV) and right inferior PV (RIPV), neglecting accessory PVs. Results: 303 patients were included, 254 (83.8%) with normal and 49 (16.2%) with atypical right PV anatomy. First freeze isolation for RSPV and RIPV occurred in 44 (89.8%) and 37 (75.5%) and in 218 (85.8%) and 217 (85.4%) patients with atypical and typical PV anatomy, respectively (p=NS). Phrenic nerve palsies (PNPs) were only observed in patients with normal anatomy (0 vs. 26, 8.6%, p=0.039). Mid-term survival free from atrial arrhythmia was similar, regardless of right PV anatomy. Conclusion: A significant proportion of patients have atypical right PV anatomy. Procedural characteristics, acute PV isolation success, and mid-term procedural efficacy are similar, regardless of right PV anatomy. In addition to left-side PVs isolation, cryoballoon ablation of RSPV and RIPV only, neglecting accessory PVs, is sufficient to obtain acute right-side PV isolation and mid-term sinus rhythm maintenance in patients with atypical anatomy.
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https://dumas.ccsd.cnrs.fr/dumas-02561940
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Submitted on : Monday, May 4, 2020 - 11:21:10 AM
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Camille Pichard. Anatomie atypique des veines pulmonaires droites et cryo-ablation de fibrillation atriale. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02561940⟩

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