Yoriaki Matsumoto1, Yuji Muraoka2, Yoshinori Funama3, Shinji Mito2, Takanori Masuda4, Tomoyasu Sato5, Tomoyuki Akita6, Kazuo Awai7. 1. Department of Radiological Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan; Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. Electronic address: yori_8592_8592@yahoo.co.jp. 2. Department of Cardiology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan. 3. Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan. 4. Department of Radiological Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan; Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. 5. Department of Radiology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan. 6. Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. 7. Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Abstract
BACKGROUND: To investigate the anatomical features related to the failure of cryoballoon (CB) ablation for atrial fibrillation (AF) on pre-procedural CT images. METHODS: We retrospectively analyzed CT images of 100 patients with AF who had undergone a first CB ablation at our institution between June 2016 and April 2017. We measured the angle, short- and long axis length, and the area and ovality of 4 major pulmonary vein (PV) ostium on CT images. We performed logistic regression analysis to analyze the anatomical features related to the failure (incomplete CB ablation) of PV isolation. We also performed a receiver-operating characteristic (ROC) curve analysis to identify an appropriate cut-off value for anatomical features significantly associated with incomplete CB ablation. RESULTS: We analyzed 400 PVs in 100 patients [aged 64 (range, 27-82) years, 59% male]. The rate of incomplete CB ablation was significantly higher for right-than left-sided PVs (p < 0.001). The anatomical feature significantly associated with incomplete CB ablation was the angle at the right inferior PV (RIPV) (AOR: 1.17; 95% CI: 1.09-1.27, p < 0.001) and the right superior PV (RSPV) (AOR: 1.12; 95% CI: 1.01-1.23; p = 0.014). In the ROC analysis, the optimal cut-off value for RIPV and RSPV angle to discriminate an incomplete CB ablation were 40.1° and 79.7°, respectively. CONCLUSION: Our findings may help to select the appropriate ablation strategy to treat patients with AF. We show that the angle is an anatomical feature significantly related to failed CB ablation.
BACKGROUND: To investigate the anatomical features related to the failure of cryoballoon (CB) ablation for atrial fibrillation (AF) on pre-procedural CT images. METHODS: We retrospectively analyzed CT images of 100 patients with AF who had undergone a first CB ablation at our institution between June 2016 and April 2017. We measured the angle, short- and long axis length, and the area and ovality of 4 major pulmonary vein (PV) ostium on CT images. We performed logistic regression analysis to analyze the anatomical features related to the failure (incomplete CB ablation) of PV isolation. We also performed a receiver-operating characteristic (ROC) curve analysis to identify an appropriate cut-off value for anatomical features significantly associated with incomplete CB ablation. RESULTS: We analyzed 400 PVs in 100 patients [aged 64 (range, 27-82) years, 59% male]. The rate of incomplete CB ablation was significantly higher for right-than left-sided PVs (p < 0.001). The anatomical feature significantly associated with incomplete CB ablation was the angle at the right inferior PV (RIPV) (AOR: 1.17; 95% CI: 1.09-1.27, p < 0.001) and the right superior PV (RSPV) (AOR: 1.12; 95% CI: 1.01-1.23; p = 0.014). In the ROC analysis, the optimal cut-off value for RIPV and RSPV angle to discriminate an incomplete CB ablation were 40.1° and 79.7°, respectively. CONCLUSION: Our findings may help to select the appropriate ablation strategy to treat patients with AF. We show that the angle is an anatomical feature significantly related to failed CB ablation.
Authors: Milena Stachyra; Marcin Szczasny; Adam Tarkowski; Magdalena Mianowana; Katarzyna Wojewoda; Katarzyna Wysokinska; Piotr Blaszczak; Andrzej Głowniak Journal: Postepy Kardiol Interwencyjnej Date: 2021-11-17 Impact factor: 1.426