Key result
3D rotational angiography fails to improve cryoballoon ablation outcomes but increases time, radiation, and contrast.
Why the study?
The impact of various imaging techniques, including intra-procedural three-dimensional rotational angiography, on the safety and outcomes of atrial fibrillation ablation remains unclear.
Does intra-procedural three-dimensional rotational angiography improve procedural success or long-term freedom from atrial fibrillation in patients undergoing cryoballoon ablation?
RCT (n=134)
Unblinded
Randomized
No
Does intra-procedural three-dimensional rotational angiography improve procedural success or long-term freedom from atrial fibrillation in patients undergoing cryoballoon ablation?
Absolute Event Rate: 86.2% vs 88.2%
p-value: p=0.798
Routine use of intra-procedural 3D rotational angiography during cryoballoon ablation for atrial fibrillation does not improve clinical outcomes but significantly increases procedure time, radiation exposure, and contrast use.
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Avoid routine 3DRA in cryoballoon AF ablation; this RCT challenges its added value.
BACKGROUND: The impact of various imaging techniques on the safety and outcomes of atrial fibrillation (AF) ablation remains unclear. Intra-procedural three-dimensional rotational angiography (3DRA) is the least used imaging method despite some benefits. The aim is to assess its impact on procedural success, safety, and long-term outcomes of cryoballoon (CB) ablation. METHODS: A single-center, unblinded, randomized controlled trial enrolled 134 patients (64.2% male, 59.0 ± 11.6 years) with paroxysmal (93.3%) or early-persistent AF. Participants were randomized to no imaging or 3DRA. Angiographic images were used to guide the ablation. Follow-up data regarding procedure and AF recurrence were collected during 12 months. RESULTS: 66 (49.3%) patients underwent 3DRA. In the control group, 2 (2.9%) pulmonary veins (PVs) could not be isolated, compared with 3 (4.5%) in the 3DRA group (p = 0.636). Procedure was longer in the 3DRA group (86.7 ± 27.8 min vs. 67.2 ± 22.1 min, p < 0.001), with significantly higher radiation dose (447.4 ± 485.0 mGy vs. 133.9 ± 166.2 mGy, p < 0.001) and contrast use (131.8 ± 28.3 mL vs. 40.8 ± 26.5 mL, p < 0.001). At 12 months, 88.2% of patients in the control group and 86.2% in the 3DRA group were free of AF (p = 0.798). CONCLUSION: 3DRA did not improve procedural success or long-term outcomes of CB ablation but significantly increased procedure time, radiation dose, and contrast usage.
Prepolec et al. (2026) conducted an RCT in Atrial fibrillation (n=134). Intra-procedural three-dimensional rotational angiography (3DRA) vs. No imaging was evaluated on Freedom from atrial fibrillation at 12 months (p=0.798). Intra-procedural 3DRA during cryoballoon ablation did not improve freedom from atrial fibrillation at 12 months compared to no imaging (86.2% vs 88.2%, p=0.798).
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