Impact of pulmonary vein anatomy assessed by cardiac magnetic resonance imaging on endoscopic pulmonary vein isolation in consecutive patients.

Aims: Recently, the novel endoscopic ablation system (EAS) was introduced and proved its potential for successful pulmonary vein isolation (PVI) in patients suffering from paroxysmal atrial fibrillation (PAF). The current study will investigate the impact of pulmonary vein (PV) anatomy assessed by pre-interventional cardiac magnetic resonance imaging (CMRI) on endoscopic PVI.

Methods And Results: Fifty-one patients (23 females, age 57 ± 9 years) with a long history (5 ± 5 years) of drug-refractory PAF were included into our analysis. Cardiac magnetic resonance imaging was performed in all patients before ablation. Each CMRI was evaluated for the number of PVs, for separate or common insertion of ipsilateral PVs, for the PV diameter and PV shape (round vs. oval), for the level of first PV branching, and for the level of insertion of the right inferior PV (RIPV) into the left atrium (LA), respectively. Pulmonary vein isolation was performed using exclusively the novel EAS. The CMRI findings were correlated with the ablation results. A total of 195 PVs were identified and targeted. In 192 of 195 (98%) PVs successful isolation was achieved using the novel EAS irrespective of the PV diameter, the PV shape, the level of PV branching, or the type of insertion of the PV into the LA. There was no statistical significance when correlating the CMRI findings with acute isolation success of the respective PVs or the number of laser applications needed until PVI (P> 0.05). A low level of insertion of the RIPV into the LA was not associated with PVI failure or a higher number of laser applications (P> 0.05).

Conclusions: The majority of PVs could have been targeted and successfully isolated using exclusively the novel EAS irrespective of their anatomy assessed by pre-interventional CMRI. Considering the economical impact of CMRI and its minor influence on ablation strategy, success, and safety it is not an essential pre-requisite for subsequent successful EAS-based PVI.