PhD Scientific Days 2026

Poster Session 3.R - Cardiovascular Medicine and Research

Pulmonary vein narrowing after initial radiofrequency catheter ablation for atrial fibrillation: a retrospective CT-based analysis

Name of the presenter

Varga, Zsofia Boglarka

Institute/workplace of the presenter

Heart and Vascular Center

Authors

Dr. Zsofia Boglarka Varga¹, Dr. Patrik Toth¹, Dr. Melinda Boussoussou¹, Dr. Ferenc Komlosi¹, Dr. Nandor Szegedi¹, Dr. Zoltan Sallo¹, Dr. Peter Perge¹, Dr. Istvan Osztheimer¹, Dr. Gabor Orban¹, Dr. Imre Szakal¹, Dr. Bence Arnoth¹, Dr. Peter Vamosi¹, Prof.Dr. Bela Merkely¹, Prof.Dr.Laszlo Geller¹, Dr. Vivien Klaudia Nagy¹
1: Heart and Vascular Center

Text of the abstract

Introduction
Pulmonary vein isolation (PVI) is the cornerstone of rhythm control therapy in atrial fibrillation (AF). Despite its safety, the procedure carries a risk of complications affecting quality of life. Pulmonary vein (PV) narrowing remains a relatively frequent finding after ablation and may reflect structural remodeling at the PV–left atrial interface. However, data on its morphological characteristics and determinants are limited.

Aims
Our goal was to assess the prevalence, morphological characteristics, and potential determinants of PV narrowing after initial radiofrequency catheter ablation (RFCA).

Methods
In this retrospective single-center study, we analyzed patients undergoing initial RFCA for paroxysmal or persistent AF between 2012 and 2023 at the Heart and Vascular Center, with available pre- and post-procedural computed tomography imaging. PV morphology was assessed using three-dimensional reconstruction, including ostial cross-sectional area and diameter-derived parameters. PV narrowing was defined as a reduction in ostial area and categorized as moderate (50–75%) or severe (>75%). Analyses were performed at patient and vein level using generalized estimating equation (GEE) models, accounting for intra-patient correlation.

Results
A total of 295 patients were included (median age 63 [53–70] years, 62.2% male, 68.1% paroxysmal AF). PV narrowing of at least moderate severity was observed in 41 patients (13.9%). Overall, 44 PVs were affected, including 39 with moderate and 5 with severe narrowing. Inferior PVs were most frequently involved, particularly the left inferior PV, followed by the right inferior and left superior veins. Increased left atrial diameter (p = 0.044) and higher left atrial volume (p = 0.024) were associated with PV narrowing. In GEE models, neither patient- nor vein-level baseline PV morphological parameters were associated with PV narrowing (p = 0.47 and p = 0.167, respectively).

Conclusion
PV narrowing after RFCA is a relatively frequent finding, predominantly affecting inferior pulmonary veins. While selected anatomical parameters and atrial remodeling show associations, baseline PV morphology does not reliably predict its occurrence after adjustment for intra-patient correlation.

Funding
No external funding was received for this study.