A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation
Omar Anwar,
Da-Un Chung,
Melanie A. Gunawardene,
Christiane Jungen,
Jens Hartmann,
Christian Meyer,
Nele Gessler,
Stephan Willems,
Samer Hakmi,
Christian Eickholt
Affiliations
Omar Anwar
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Da-Un Chung
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Melanie A. Gunawardene
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Christiane Jungen
DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
Jens Hartmann
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Christian Meyer
Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, 40217 Düsseldorf, Germany
Nele Gessler
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Stephan Willems
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Samer Hakmi
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Christian Eickholt
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: Patients with paroxysmal and recently diagnosed persistent AF undergoing CB-based PVI from January 2015 to December 2017 were retrospectively analyzed. Patients underwent either selective PV angiography or conventional left atrial (LA) angiography for PV visualization. Results: A total of 336 patients were analyzed. A total of 87 patients (26%) received PV angiography and 249 (74%) LA angiography. LA angiography required fewer cine-sequences for PV visualization, translating into a significant reduction in procedure duration, fluoroscopy time and dose area product. Additionally, less contrast medium was utilized. PV occlusion by the CB, CB temperature and time to isolation showed no significant differences. The number of CB applications and total application time (LA angiography: 1.4 ± 0.02 vs. PV Angiography: 1.6 ± 0.05; p p p = 0.2657). Conclusions: A simplified protocol, using LA angiography for PV visualization, entails a reduction in procedure time and radiation exposure while equally maintaining procedural efficiency and safety in both groups.
