Why the study?
Selective PV angiography is the gold standard for PV visualization in cryoballoon-based PVI, but a simplified approach was sought to reduce procedural complexity and radiation exposure.
Does conventional left atrial angiography reduce procedure duration and radiation exposure compared to selective pulmonary vein angiography in patients undergoing cryoballoon ablation for atrial fibrillation?
Does conventional left atrial angiography reduce procedure duration and radiation exposure compared to selective pulmonary vein angiography in patients undergoing cryoballoon ablation for atrial fibrillation?
Using conventional left atrial angiography instead of selective PV angiography during cryoballoon ablation reduces procedure time and radiation exposure without compromising safety or efficacy.
Answers are grounded in this paper and cite their sources.
LA angiography was associated with shorter procedures and less radiation in cryoballoon ablation; leaves open whether randomized trials confirm AF recurrence equivalence.
Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: Patients with paroxysmal and recently diagnosed persistent AF undergoing CB-based PVI from January 2015 to December 2017 were retrospectively analyzed. Patients underwent either selective PV angiography or conventional left atrial (LA) angiography for PV visualization. Results: A total of 336 patients were analyzed. A total of 87 patients (26%) received PV angiography and 249 (74%) LA angiography. LA angiography required fewer cine-sequences for PV visualization, translating into a significant reduction in procedure duration, fluoroscopy time and dose area product. Additionally, less contrast medium was utilized. PV occlusion by the CB, CB temperature and time to isolation showed no significant differences. The number of CB applications and total application time (LA angiography: 1.4 ± 0.02 vs. PV Angiography: 1.6 ± 0.05; p < 0.0001; LA angiography: 297.9 ± 4.62 vs. PV-Angiography: 348.9 ± 11.03; p < 0.001, respectively) per vein were slightly but significantly higher in the PV angiography group. We observed no difference in late AF recurrence (24.7% LA angiography vs. 21.3% PV angiography; p = 0.2657). Conclusions: A simplified protocol, using LA angiography for PV visualization, entails a reduction in procedure time and radiation exposure while equally maintaining procedural efficiency and safety in both groups.
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Anwar et al. (2022) studied this question.
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