ABC | Volume 110, Nº5, May 2018

Original Article Chen et al PV anatomy and cryo kinetics Arq Bras Cardiol. 2018; 110(5):440-448 Figure 4 – Univariate and multivariate logistic regression analysis for BNT (< -51°C and ≥ -51°C). A and C. Univariate and multivariate analysis of 23mm CB. B and D. Univariate and multivariate analysis of 28 mm CB. D long: PV ostium long diameter; D short : PV ostium short diameter; D corrected : Corrected diameter calculated from PV ostium perimeter PV ostium; CB: cryoballoon; LSPV: left superior pulmonary vein; LIPV: left inferior pulmonary vein; RIPV: right inferior pulmonary vein; RSPV: right superior pulmonary vein. D corrected (per mm) D corrected (per mm) D corrected (per mm) D short / D long (per 0.1) Oval Oval Triangular Triangular Narrow Narrow with common trunk with common antrum with ostial branch LIPV LIPV RIPV RIPV LIPV RIPV D corrected (per mm) D short / D long (per 0.1) Oval Triangular Narrow with common trunk with common antrum with ostial branch with supernumerary vein LIPV RIPV RSPV RSPV 0 1 2 0 1 2 3 4 5 6 7 8 9 212 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 12 13 14 15 163 OR [95% Cl] 0.98 [0.8, 1.1] 0.3 [0.1, 0.9] 1.9 [0.3, 12] OR [95% Cl] 1.4 [1.1, 1.8] 0.2 [0.03, 1.0] 0.2 [0.03, 1.0] 0.4 [0.1, 2.1] 0.04 [0, 0.4] 0.3 [0.1, 1.4] 4.3 [1.2, 15] OR [95% Cl] 1.2 [1.1, 1.4] 10 [0.6, 163] 0.4 [0.2, 0.8] 0.8 [0.2, 2.8] 0.3 [0.1, 1.1] 0.7 [0.2, 2.7] 0.6 [0.3, 1.6] 0.8 [0.3, 2.1] 1.3 [0.3, 5.7] 0.05 [0.01, 0.4] 0.4 [0.1, 1.2] 3.0 [1.1, 7.9] OR [95% Cl] 1.6 [1.3, 2.0] 8.1 [0.3, 212] 0.7 [0.2, 3.0] 0.9 [0.1, 2.0] 0.4 [0.1, 2.2] 0.6 [0.1, 2.6] 0.7 [0.2, 1.7] 2.0 [0.5, 7.4] 0.1 [0.02, 0.5] 0.2 [0.04, 1.0] A C D B Univariate Analysis, 23 mm CB Multivariate Analysis, 23 mm CB Multivariate Analysis, 28 mm CB Univariate Analysis, 28 mm CB PN palsy occurs more frequently in right PVs with an incidence of 2.0% ~ 24.4%. 12,19,20 Our study demonstrated that the overall complication rate were not significantly different between using the two CBs, while ablation using 23-mm CB only had a similar rate of acute PVI on PV level and nonsignificant higher rate on patient level comparing with using 28-mm CB only. It is worth mention that the only one case of PN palsy (1.7%) occurred when using 28-mm balloon, this indicates that, with the improvement of operators’ skills and monitoring methods, smaller CB can be just as safe as the bigger CB while achieving comparable or even higher efficacy when using for the selected patients. Study limitation In this single-center study with a small sample, PV anatomy variations might only partially represent the universal situation among population; BNT cut-point < -51°C was just used to facilitate the analysis and it is not a cut-point between effective and non-effective ablation, so was the cryo kinetic effect not equal to ablation effect. As SCs were used not only to record PV potentials, but also to support the CBs, real-time PV isolation recording, a more direct and better parameter to evaluate acute ablation effect, could only be achieved in some of the patients. However, this situation is expected to change with the progress of technology and manipulation skills, 21 and investigation of relationship between PV anatomy and real time isolation will be the future research direction. Current results only apply to the use of first-generation CB. With the spreading use of CB second generation, cryo kinetics needs further discussion. In addition, the evaluation of PV anatomy was carried out with Carto system in electrophysiological lab for convenience and efficiency. Other post processing platforms and reconstructing software could also be used for analysis. Conclusions MDCT images can provide accurate evaluation of PV ostial anatomy and preprocedural guidance for CB ablation. PV anatomy is associated with cryo kinetics, and PV diameter plays a more prominent role when using 23-mm CBs, while PV location is more prominent when using 28-mm CBs. Author contributions Conception and design of the research: Xiongbiao C, Pihua F, Tang M; Acquisition of data and Critical revision of the manuscript for intellectual content: Xiongbiao C, Pihua F, Zheng L, Jia H, Tang M, Jun L, Bin L, Shu Z; Analysis and interpretation of the data: Xiongbiao C, Pihua F, Zheng L, Jia H, Tang M, Jun L, Bin L; Statistical analysis: Xiongbiao C, Pihua F, Zheng L, Jun L; Writing of the manuscript: Xiongbiao C. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. 446