Richard Ang1, Ross J Hunter2, Victoria Baker2, Laura Richmond2, Mehul Dhinoja2, Simon Sporton2, Richard J Schilling2, Francesca Pugliese2, Ceri Davies2, Mark Earley3. 1. Barts Heart Centre, St Bartholomew's Hospital, Bart's & The London NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, UK. Electronic address: richardang@mac.com. 2. Barts Heart Centre, St Bartholomew's Hospital, Bart's & The London NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, UK. 3. Barts Heart Centre, St Bartholomew's Hospital, Bart's & The London NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, UK. Electronic address: mark.earley@bartshealth.nhs.uk.
Abstract
OBJECTIVE: We tested the hypothesis that pulmonary vein (PV) measurements on pre-procedural CT/MR imaging can predict difficulty in isolation and phrenic nerve (PN) injury during cryoballoon ablation for paroxysmal atrial fibrillation (AF). METHODS:Consecutive patients with paroxysmal AF who had pre-procedural CT/MRI and underwentcryoballoon ablation as part of a randomized trial were studied. Imaging was anonymized for blinded analysis of: (1) maximum ostial diameter, (2) minimum ostial diameter, (3) ostial area and (4) ratio of maximum over minimum ostial diameter (eccentricity index). Veins that required more than 2 freezes of at least 200 s duration to isolate or not isolated were defined as difficult to isolate. Loss of PN pacing during right-sided ablation was defined as PN injury. Logistic regression was used to analyze the predictive effect of the measurements on the 2 outcomes. RESULTS:148 PVs in 38 patients (aged 60 ± 11 years, 76% male) were analyzed. Left inferior PV (LIPV) was most difficult to isolate with 23 out of 37 PVs (62%), and PN injury occurred in 3 of 38 (8%) right superior PV (RSPV). Greater eccentricity index predicted difficulty in isolating LIPV, OR 40.33 (95% CI 1.40 to 1160, p = 0.03) and smaller eccentricity index predicted PN injury in RSPV, OR 0.01 (95% CI 0.01-0.16, p = 0.001). CONCLUSIONS:Eccentricity index measured from pre-procedural CT/MR imaging can predict difficulty of PV isolation and PN injury during cryoballoon ablation for paroxysmal AF.
RCT Entities:
OBJECTIVE: We tested the hypothesis that pulmonary vein (PV) measurements on pre-procedural CT/MR imaging can predict difficulty in isolation and phrenic nerve (PN) injury during cryoballoon ablation for paroxysmal atrial fibrillation (AF). METHODS: Consecutive patients with paroxysmal AF who had pre-procedural CT/MRI and underwent cryoballoon ablation as part of a randomized trial were studied. Imaging was anonymized for blinded analysis of: (1) maximum ostial diameter, (2) minimum ostial diameter, (3) ostial area and (4) ratio of maximum over minimum ostial diameter (eccentricity index). Veins that required more than 2 freezes of at least 200 s duration to isolate or not isolated were defined as difficult to isolate. Loss of PN pacing during right-sided ablation was defined as PN injury. Logistic regression was used to analyze the predictive effect of the measurements on the 2 outcomes. RESULTS: 148 PVs in 38 patients (aged 60 ± 11 years, 76% male) were analyzed. Left inferior PV (LIPV) was most difficult to isolate with 23 out of 37 PVs (62%), and PN injury occurred in 3 of 38 (8%) right superior PV (RSPV). Greater eccentricity index predicted difficulty in isolating LIPV, OR 40.33 (95% CI 1.40 to 1160, p = 0.03) and smaller eccentricity index predicted PN injury in RSPV, OR 0.01 (95% CI 0.01-0.16, p = 0.001). CONCLUSIONS: Eccentricity index measured from pre-procedural CT/MR imaging can predict difficulty of PV isolation and PN injury during cryoballoon ablation for paroxysmal AF.
Authors: Valter Giaretto; Andrea Ballatore; Claudio Passerone; Paolo Desalvo; Mario Matta; Andrea Saglietto; Mario De Salve; Fiorenzo Gaita; Bruno Panella; Matteo Anselmino Journal: J R Soc Interface Date: 2019-09-18 Impact factor: 4.118
Authors: Bart A Mulder; Meelad I H Al-Jazairi; Bauke K O Arends; Niels Bax; Leonard A Dijkshoorn; Uzaifa Sheikh; Eng S Tan; Ans C P Wiesfeld; Robert G Tieleman; Rozemarijn Vliegenthart; Michiel Rienstra; Isabelle C van Gelder; Yuri Blaauw Journal: Clin Cardiol Date: 2019-03-13 Impact factor: 2.882