Abstract
AimsCryoballoon pulmonary vein (PV) isolation in patients with atrial fibrillation has proven to be effective in short-term and long-term follow-up. To visualise the PV anatomy, pre-ablation contrast pulmonary venography is commonly performed. Three-dimensional (3D) computed tomography (CT) overlay is a new technique creating a live 3D image of the left atrium by integrating a previously obtained CT scan during fluoroscopy. To evaluate the benefits of 3D CT overlay during cryoballoon ablation, we studied the use of 3D CT overlay versus contrast pulmonary venography in a randomised fashion in patients with paroxysmal atrial fibrillation undergoing cryoballoon PV isolation.Methods and resultsBetween October 2012 and June 2013, 30 patients accepted for PV isolation were randomised to cryoballoon PV isolation using either 3D CT overlay or contrast pulmonary venography. All patients underwent a pre-procedural cardiac CT for evaluation of the anatomy of the left atrium (LA) and the PVs. In the 3D CT overlay group, a 3D reconstruction of the LA and PVs was made. An overlay of the CT reconstruction was then projected over live fluoroscopy. Patients in the contrast pulmonary venography group received significantly more contrast agent (77.1 ± 21.2 cc vs 40.1 ± 17.6 cc, p < 0.001) and radiation (43.0 ± 21.9 Gy.cm2 vs 28.41 ± 11.7 Gy.cm2, p = 0.04) than subjects in the 3D CT overlay group. There was no difference in total procedure time, fluoroscopy time and the amount of cryoapplications between the two groups.ConclusionThe use of 3D CT overlay decreases radiation and contrast dye exposure and can assist in guiding cryoballoon-based PV isolation.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia, affecting approximately 1.5–2% of the general population [1]
To evaluate the benefits of 3D computed tomography (CT) overlay during cryoballoon ablation, we studied the use of 3D CT overlay versus contrast pulmonary venography in a randomised fashion in consecutive patients with paroxysmal AF undergoing cryoballoon pulmonary vein (PV) isolation
Two patients were excluded because PV isolation could not be completed with the cryoballoon alone and additional radiofrequency applications during the same procedure were needed to achieve PV isolation
Summary
Atrial fibrillation (AF) is the most common arrhythmia, affecting approximately 1.5–2% of the general population [1]. In 1998, the pulmonary veins (PVs) were identified as potential targets for the invasive treatment of AF [2]. PV isolation is an effective treatment for patients with symptomatic paroxysmal AF and recommended in international guidelines [1]. Ablation success rates at 12 months range between 66 and 89% [3,4,5]. Radiofrequency ablation requires tedious point-to-point delivery of multiple applications to isolate PVs [6]. More circular ablation catheters have been developed facilitating PV isolation. Ablation using a cryoballoon has been proven effective in short and long-term follow-up, with equal efficacy and safety, compared with the conventional radiofrequency approach [6,7,8,9,10]
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