Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy

insights from the 1STOP project

A. Sagone, S. Iacopino, P. Pieragnoli, G. Arena, R. Verlato, G. Molon, G. Rovaris, A. Curnis, W. Rauhe, M. Lunati, G. Senatore, M. Landolina, G. Allocca, S. De Servi, C. Tondo

Research output: Contribution to journalArticle

Abstract

Background: Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence. Methods: Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging. Results: Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390). Conclusions: In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Pulmonary Veins
Atrial Fibrillation
Anatomy
Cryosurgery
Respiratory Paralysis
Fluoroscopy
Heart Atria
Recurrence
Therapeutics

Keywords

  • AF recurrences
  • Cardio imaging
  • Cryoballoon
  • Outcomes
  • Paroxysmal atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy : insights from the 1STOP project. / Sagone, A.; Iacopino, S.; Pieragnoli, P.; Arena, G.; Verlato, R.; Molon, G.; Rovaris, G.; Curnis, A.; Rauhe, W.; Lunati, M.; Senatore, G.; Landolina, M.; Allocca, G.; De Servi, S.; Tondo, C.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Sagone, A. ; Iacopino, S. ; Pieragnoli, P. ; Arena, G. ; Verlato, R. ; Molon, G. ; Rovaris, G. ; Curnis, A. ; Rauhe, W. ; Lunati, M. ; Senatore, G. ; Landolina, M. ; Allocca, G. ; De Servi, S. ; Tondo, C. / Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy : insights from the 1STOP project. In: Journal of Interventional Cardiac Electrophysiology. 2019.
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T1 - Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy

T2 - insights from the 1STOP project

AU - Sagone, A.

AU - Iacopino, S.

AU - Pieragnoli, P.

AU - Arena, G.

AU - Verlato, R.

AU - Molon, G.

AU - Rovaris, G.

AU - Curnis, A.

AU - Rauhe, W.

AU - Lunati, M.

AU - Senatore, G.

AU - Landolina, M.

AU - Allocca, G.

AU - De Servi, S.

AU - Tondo, C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence. Methods: Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging. Results: Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390). Conclusions: In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.

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KW - AF recurrences

KW - Cardio imaging

KW - Cryoballoon

KW - Outcomes

KW - Paroxysmal atrial fibrillation

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