Pulmonary vein to ganglionated plexi distance predicts cryoballoon ganglionated plexi modification.

BACKGROUND: Cryoballoon ablation (CBA) for atrial fibrillation (AF) can cause incidental modification of ganglionated plexi (GP), which may contribute to arrhythmia control; however, the anatomic factors associated with GP modification remain poorly understood. OBJECTIVE: We investigated the relationship between the distance from the pulmonary vein-left atrial (PV-LA) junction to GP sites and GP modification during CBA using voltage mapping. METHODS: This retrospective study analyzed 50 patients with paroxysmal AF undergoing CBA. Preprocedural computed tomography images were integrated into a 3-dimensional electroanatomic mapping system to measure PV-LA junction to GP (PV-GP) distances. GP modification was defined as voltage attenuation at GP sites after ablation. Receiver operating characteristic analysis was performed to assess predictive performance. RESULTS: GP modification occurred more frequently at sites located closer to the PV-LA junction. Upper GP regions demonstrated higher modification rates than lower regions, and PV-GP distance showed reasonable discrimination for predicting GP modification. CONCLUSION: Anatomic proximity between the PV-LA junction and GP seems to be a key determinant of GP modification during CBA. Quantitative assessment of PV-GP distance may help predict autonomic effects and support optimization of AF ablation strategies.