Received: 28 June 2019 Revised: 11 September 2019 Accepted: 22 September 2019 DOI: 10.1111/pace.13810 ELECTROPHYSIOLOGY Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins Hugo-Enrique Coutiño MD, PhD ∗ Erwin Ströker MD ∗ Ken Takarada MD Giacomo Mugnai MD, PhD Juan-Pablo Abugattas MD Juan Sieira MD, PhD Francesca Salghetti MD Muryo Terasawa MD Varnavas Varnavas MD, PhD Riccardo Maj MD Thiago Guimarães Osório MD Diego Neach MD Pedro Brugada MD, PhD Carlo de Asmundis MD, PhD † Gian-Battista Chierchia MD, PhD † Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium Correspondence Erwin Ströker, MD, Heart Rhythm Management Centre, UZ Brussel-VUB, 101 Laarbeeklaan, 1090 Brussels, Belgium. Email: erwin.stroker@uzbrussel.be ∗ Hugo-Enrique Coutiño and Erwin Ströker contributed equally to the article as first authors. † Gian-Battista Chierchia and Carlo de Asmundis contributed equally to the article as senior authors. Abstract Background: A left common pulmonary vein (LCPV) accounts as the most frequent pulmonary vein (PV) variation. Our aim was to compare the performance of radiofrequency (RF) versus second-generation cryoballoon (CB-A) ablation in patients with atrial fibrillation (AF) and LCPVs. Methods: In a total cohort of 716 patients undergoing PV isolation with preprocedural CT- scanning, LCPV+ patients were selected with measurement of PV ostial area and trunk distance. All LCPV+ patients were matched between RF and CB-A group in a 1:1 ratio based on propensity scores, and compared for outcome. Results: Left common pulmonary veins were found in 31% (88/283) RF versus 34% (146/433) CB- A patients, respectively, (P = .44). In the matched population of 83 LCPV+ patients in each group, electrical isolation could be achieved in all left-sided PVs. No significant difference was noted for the rate of AF/left atrial tachyarrhythmia (LAT) recurrence between RF and CB-A group (30% vs 28%, P = .86), with similar AF/LAT-free survival (log rank, P = .71). There were 48 patients with AF/LAT recurrence (29%) during the follow-up. Recurrence rate between paroxysmal versus per- sistent AF was 27/120 (22.5%) versus 21/46 (46%), P = .004. Cox proportional regression analysis withheld LA volume and persistent AF as independent variables to predict AF/LAT recurrence. No increased hazard for AF/LAT recurrence was observed for patients with a long (>15 mm) vs short (5-15 mm) LCPV trunk (OR 1.14, 95% CI 0.6-2.2, P = .7). Conclusions: In our study, equal efficacy and outcome was noted in LCPV+ patients between RF and CB-A technology. KEYWORDS atrial fibrillation, left common pulmonary veins, pulmonary vein isolation, radiofrequency, second- generation cryoballoon 1 INTRODUCTION Pulmonary vein isolation (PVI) is currently a well-established interven- tional treatment for drug-resistant atrial fibrillation (AF). 1,2 Pulmonary venous anatomy variations may have important implications on the ablation strategies used. A left common pulmonary vein (LCPV) is the most frequent anatomical pulmonary vein (PV) variation followed by an additional right middle PV. The incidence of LCPVs differs consid- erably according to different studies between 9% and 83%. 3,4 The- oretically, anatomy of PV ostia could be relevant as a predisposing Pacing Clin Electrophysiol. 2019;1–7. c  2019 Wiley Periodicals, Inc. 1 wileyonlinelibrary.com/journal/pace