Impact of left common pulmonary veins in the contact force versus cryoballoon atrial fibrillation ablation (CIRCA-DOSE) study

Background: Concerns remain regarding the effectiveness of pulmonary vein isolation (PVI) using the fixed diameter noncompliant cryoballoon in the presence of a left common pulmonary vein (LCPV). We sought to evaluate the effectiveness of PVI performed by contact force–guided radiofrequency (CF-RF) versus second-generation cryoballoon-based ablation in patients with LCPV. Methods and Results: We enrolled 346 patients with paroxysmal atrial fibrillation (AF) and randomized them to CF-RF or cryoballoon ablation. Pulmonary vein (PV) anatomy was not assessed before enrollment, and there were no exclusions based on PV anatomy. All patients received an implantable cardiac monitor. LCPV was observed in 13.6% of patients (47 of 346). Left atrial time and fluoroscopy time did not differ between those with and without LCPV (p =.58 and p =.06, respectively). Freedom from any atrial tachyarrhythmia at 1 year was observed in 46.8% with LCPV and 54.5% without LCPV (p =.06). In those with LCPV, the freedom from any atrial tachyarrhythmia did not differ between those randomized to CF-RF or cryoballoon ablation (hazard ratio for recurrence: 1.19, 95% confidence interval: 0.53–2.65, p =.69). In those with LCPV, the AF burden was reduced to a similar extent with CF-RF and cryoballoon ablation (99.7% vs. 99.5%, respectively; p =.97). Conclusions: In this randomized clinical trial, the presence of an LCPV was associated with a trend towards higher rates of arrhythmia recurrence following PVI. No significant difference in arrhythmia recurrence was observed between patients with LCPV randomized to cryoballoon ablation or CF-RF ablation, suggesting that either ablation modality is suitable in this population.