ABC | Volume 111, Nº6, December 2018

Original Article Odozynski et al PV anatomy and AF ablation Arq Bras Cardiol. 2018; 111(6):824-830 Table 1 – Clinical characteristics of patients undergoing AF ablation, categorization by presence of common trunk of the pulmonary veins Variables n-LCT (n = 142) LCT (n = 30) p-value Age (years) 58.1 ± 10 62.5 ± 11 0.11 Gender (Male) 101 (71) 20 (69.2) 0.64 BMI 27.6 ± 4.5 26.6 ± 3.5 0.37 LV ejection fraction - % 64.4 ± 8.7 (33 – 86) 66.2 ± 8.5 (46 – 77) 0.33 Diameter of the LA - mm 38 ± 5.2 (27 – 53) 38.7 ± 6.3 (31 – 50) 0.76 Comorbidities SAH 82 (58.3) 18 (61.9) 0.75 DM2 16 (11) 4 (13.3) 0.54 CAD 30 (21) 4 (13.3) 0.63 Prior Stroke/TIA 6 (4.2) 1 (3.3) 0.86 CCF 10 (7) 3 (10) 0.41 CHA2DS2-VASc 1.49 ± 1.2 1.0 ± 1.9 0.49 AF - Symptoms CCS SAF score 2.07 ± 0.8 1.9 ± 0.8 0.46 EHRA score 2.04 ± 0.3 2.1 ± 0.5 0.33 Medications Statins 41 (28) 12 (40) 0.12 ACE or ARA Inhibitor 45 (31) 13 (42) 0.21 Antiarrhythmic medication 121 (85) 22 (73) 0.44 Values with ± indicate mean and standard deviation; BMI: body mass index; LV: left ventricle; LA: left atrium; SAH: systemic arterial hypertension; CAD: coronary artery disease; Stroke / TIA: stroke / transient ischemic attack; CCS SAF: Canadian Cardiovascular Society Severity of Atrial Fibrillation scale; EHRA: European Heart Rhythm Association; ACE: angiotensin converting enzyme; AF: atrial fibrillation; ARA: Angiotensin receptor antagonist 2. Student’s t test and χ 2 for independent samples. * p-value indicates a statistically significant difference at the level of 5%. Table 2 – Efficacy of procedures and complications categorized by presence of left common trunk of the pulmonary veins Procedures n-LCT (n = 142) LCT (n = 30) OR p-value AF relapse 39 (27) 3 (10) 3.4 0.04* Follow-up time 34 ± 17 26 ± 15 - 0.37 Complications Pseudoaneurysm 4 (3) 0 (0) - 0.55 Inguinal hematoma 1 (0.7) 0 (0) - 0.86 AF: atrial fibrillation; OR: Odds ratio; NA: not applicable; Student t test and χ 2 for independent samples. * p-value indicates a statistically significant difference at the level of 5%. In the present case-control/single-centered study of patients undergoing the first ablation procedure for PAF, it is suggested that - in comparison to the standard anatomy - the presence of the LCT favors the results in the percutaneous treatment of AF, with lower recurrence rate and low complication rates in a long-term analysis. These findings highlight the importance of knowing PVs anatomy for the efficacy and safety of AF ablation. The definition of LCT (approximately 20% of the sample) deserves discussion. In general, the diagnosis is quite simple, through detomography or cardiac resonance. In our study, we chose an unequivocal definition of common trunk, that is, when there was a minimum distance of 10 mm between the common ostium of the left PVs and the bifurcation of their left lower and upper branches. Thus, the diagnosis of LCT was intentionally simplified. This aspect has important clinical relevance. When identifying LCT, the clinical decision for catheter ablation can be simplified because the patient with this type of anatomical change has an excellent clinical result after ablation. In fact, there was no comparison between ablation and the use of antiarrhythmic drugs in this subgroup, but it is worth remembering that all patients ablated in our study were unresponsive to antiarrhythmic drugs. This observation has an important practical effect. In clinical practice, it is not uncommon that patients with AF and anatomically normal heart by transthoracic echocardiography undergo numerous diagnostic tests. As a rule, these patients undergo multiple stress tests, 827