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Volume 58
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Article

A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation

by
Omar Anwar
1,2,*,†,
Da-Un Chung
1,†,
Melanie A. Gunawardene
1,2,
Christiane Jungen
2,3,
Jens Hartmann
1,2,
Christian Meyer
4,5,
Nele Gessler
1,2,
Stephan Willems
1,2,
Samer Hakmi
1,2 and
Christian Eickholt
1,6
1
Department of Cardiology and Intensive Care Medicine, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany
2
DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
3
Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, 20251 Hamburg, Germany
4
Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, 40217 Düsseldorf, Germany
5
Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Institute for Neural and Sensory Physiology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
6
Department of Cardiology, Klinikum Itzehoe, 25524 Itzehoe, Germany
*
Author to whom correspondence should be addressed.
†
Authors have contributed equally to this work.
Medicina 2022, 58(12), 1700; https://doi.org/10.3390/medicina58121700
Submission received: 13 October 2022 / Revised: 11 November 2022 / Accepted: 18 November 2022 / Published: 22 November 2022
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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Abstract

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.
Keywords: atrial fibrillation; cryoballoon; pulmonary vein isolation; angiography atrial fibrillation; cryoballoon; pulmonary vein isolation; angiography

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MDPI and ACS Style

Anwar, O.; Chung, D.-U.; Gunawardene, M.A.; Jungen, C.; Hartmann, J.; Meyer, C.; Gessler, N.; Willems, S.; Hakmi, S.; Eickholt, C. A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation. Medicina 2022, 58, 1700. https://doi.org/10.3390/medicina58121700

AMA Style

Anwar O, Chung D-U, Gunawardene MA, Jungen C, Hartmann J, Meyer C, Gessler N, Willems S, Hakmi S, Eickholt C. A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation. Medicina. 2022; 58(12):1700. https://doi.org/10.3390/medicina58121700

Chicago/Turabian Style

Anwar, Omar, Da-Un Chung, Melanie A. Gunawardene, Christiane Jungen, Jens Hartmann, Christian Meyer, Nele Gessler, Stephan Willems, Samer Hakmi, and Christian Eickholt. 2022. "A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation" Medicina 58, no. 12: 1700. https://doi.org/10.3390/medicina58121700

APA Style

Anwar, O., Chung, D.-U., Gunawardene, M. A., Jungen, C., Hartmann, J., Meyer, C., Gessler, N., Willems, S., Hakmi, S., & Eickholt, C. (2022). A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation. Medicina, 58(12), 1700. https://doi.org/10.3390/medicina58121700

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