Intra-procedural three-dimensional rotational angiography in cryoballoon ablation for atrial fibrillation
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ORIGINAL PAPER
Intra‑procedural three‑dimensional rotational angiography in cryoballoon ablation for atrial fibrillation Vedran Velagic1 · Giacomo Mugnai2 · Domagoj Kardum1 · Ivan Prepolec1 · Vedran Pasara1 · Mislav Puljevic1 · Davor Puljevic1 · Ivo Planinc1 · Jure Samardzic1 · Maja Cikes1 · Davor Milicic1 Received: 18 May 2020 / Accepted: 13 September 2020 © Springer Nature B.V. 2020
Abstract Cryoballoon (CB) is an established technology for atrial fibrillation (AF) ablation and is usually performed using solely fluoroscopy. We aimed to study the feasibility of three-dimensional rotational angiography (3DRA) as intra-procedural imaging in CB ablation. Analyzed data were retrospectively collected from patients that underwent second generation CB ablation from February 2015 to August 2017. We studied 68 consecutive patients that received 3DRA (3DRA group). Sixtysix patients who received conventional X-ray imaging served as a control group. 3DRA was performed via an introducer placed in the left atrium. Angiographic images were segmented and fused with live fluoroscopy to guide the ablation. We have analyzed 134 CB patients (73.8% male, 56.9 ± 11.4 years). Paroxysmal AF was present in 77.6% of patients. 3DRA was successfully performed in all 3DRA group patients. The mean procedure time was significantly shorter in the control group (82.4 ± 26.3 min) than in the 3DRA group (121.1 ± 21.4 min) (p < 0.0001). Total radiation dose (419.3 ± 317.9 vs 998.3 ± 673 mGy, p < 0.0001) and contrast administration (83.2 ± 22.3 mL vs 191.6 ± 33.4 mL, p < 0.0001) were significantly lower in control group. There was no significant difference in 2-year success rate, 35.2% of patients had AF recurrence in the 3DRA group and 30.3% in the control group (p = 0.584). Major complications occurred in 2.9% and 1.5% of patients in 3DRA group and control group, respectively (p = 1.000). 3DRA is a feasible method of intra-procedural imaging to guide CB ablation. However, it prolongs procedure time, increases radiation dose and contrast administration with no significant effect on procedure outcomes and complication rates. Keywords Imaging · Atrial fibrillation · Cryoballoon ablation · Rotational angiography
Introduction Pulmonary vein isolation (PVI) has become the standard of care for patients with atrial fibrillation (AF) with an evergrowing demand for the procedure [1]. Cryoballoon (CB) technology is currently the only established “single-shot” ablation modality and is characterized by fast learning curves and a good safety profile [2, 3]. In the vast majority of cases, CB ablation is performed using solely conventional * Vedran Velagic [email protected] 1
Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
2
X-ray imaging. However, integration of left atrial (LA) images obtained by computer tomogr
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