Impact of left atrial CT-angiography prior cryoballoon pulmonary vein isolation on procedural characteristics and outcomes

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Cryoballoon (CB) ablation for pulmonary vein isolation (PVI) is a frequently performed procedure for rhythm control therapy in atrial fibrillation (AF). However, there is limited data on the impact of preprocedural computed tomography (CT) imaging on procedural characteristics and outcomes. PURPOSE: We aimed to determine whether the use of left atrial CT-angiography to guide CB ablation makes a difference on procedural outcomes by revealing left atrial (LA) anatomy and pulmonary vein (PV) characteristics. METHODS: A total of 146 AF patiens (paroxismal: 58%, age: 62 ±11 years) undergoing CB ablation were randomized for conventional PVI (control group, n=74) and PVI following preoperative CT-angiography (CTA group, n=72). In the CTA group, LA and PV anatomical features were available during the procedure using 3-dimensional reconstruction images derived from an electroanatomical mapping system. A strategy of 240-second freeze time was used for each pulmonary vein with an option for extra freeze circles until PVI was achieved. RESULTS: Procedural time (51±13 min vs. 58±21 min, p<0.05), LA dwell time (41±11 min vs. 47±20 min, p<0.05) and fluoroscopy time (9±4 min vs. 11±5 min, p<0.05) were significantly shorter in the control group. Fluoroscopy dose (1892.4±1319.7 cGycm2 vs. 2216.6±2371.8 cGycm2, p=0.307) and 12-month success rates (control group: 61%; CTA group: 62%, p=0.835) were comparable. No major complications were observed. CONCLUSIONS: The additional information on anatomy provided by left atrial CT angiography does not manifest in improved procedural characteristics or clinical outcome. Our findings do not support the routine use of preprocedural CTA for guidance of cryoballoon ablation.