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Intra-procedural three-dimensional rotational angiography in cryoballoon ablation for atrial fibrillation

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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). Sixty-six 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.

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Funding

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Vedran Velagic, Domagoj Kardum, Ivan Prepolec, Vedran Pasara, Mislav Puljevic, Davor Puljevic, Ivo Planinc, Jure Samardzic, Maja Cikes & Davor Milicic

  2. Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy

    Giacomo Mugnai

Authors
  1. Vedran Velagic
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  2. Giacomo Mugnai
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  3. Domagoj Kardum
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  4. Ivan Prepolec
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  6. Mislav Puljevic
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  10. Maja Cikes
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  11. Davor Milicic
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Contributions

VV and MG were responsible for conception of the study and drafting of the manuscript. DK, PV, PI, IP and PM were responsible for acquisition and analysis of the data. JS, MC, DP and DM were responsible for critical revision of the manuscript and important intellectual content.

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Correspondence to Vedran Velagic.

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Conflict of interest

VV received educational Grants by St Jude Medical, travel Grants and lecture fees from Medtronic and Biosense-Webster. MC received lecture fees from Medtronic. MP received educational and travel Grants from Medtronic and Biosense-Webster.

Ethics approval

Ethical approval was waived by the local Ethics Committee of University Hospital Centre Zagreb in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Velagic, V., Mugnai, G., Kardum, D. et al. Intra-procedural three-dimensional rotational angiography in cryoballoon ablation for atrial fibrillation. Int J Cardiovasc Imaging 37, 389–397 (2021). https://doi.org/10.1007/s10554-020-02029-7

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  • DOI: https://doi.org/10.1007/s10554-020-02029-7

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