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Curso de Atualização em Medicina Cardiovascular 2019
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Pulmonary vein CT evaluation for atrial fibrillation cryoballoon ablation: when anatomy matters
Session:
Posters 2 - Écran 6 - Arritmologia
Speaker:
Fernando Montenegro Sá
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Fernando Montenegro Sá; Marisa Passos Silva; Paulo Fonseca; Marco André Oliveira; Helena Gonçalves; Joana Silveira; Nuno Dias Ferreira; Wilson Ferreira; João Primo; Pedro Braga
Abstract
<p><strong>Introduction: </strong>Cryoballoon ablation is a widely accepted method for pulmonary vein (PV) isolation in atrial fibrillation (AF) therapy. Its results depend on achieving total PV occlusion with a balloon that has a standard predefined size and shape that needs to adapt to the different PV anatomy.</p> <p><strong>Aim: </strong>To evaluate the impact of PV anatomy (number of veins, presence of common trunks, ostial area and ovality) during cryoballoon PV isolation and AF recurrence rate.</p> <p><strong>Methods: </strong>Retrospective analysis of 162 consecutive patients undergoing cryoballoon ablation that were previously submitted to a multi-slice cardiac computed tomography. We analyzed 599 PV with dimension measurement through Syngo dynamics® software. As in previous trials, the ovality index (OI) was calculated as: 2x(a-b)/(a+b) - being "a" the longer and "b" the shorter diameter, - and an OI>0,30 was the defined cut-off for ovality. A temperature of -40ºC was determined as goal temperature. With a mean follow-up of 16.0 ± 8.4 months, AF recurrence was evaluated through 24 hour holter monitoring. In order to determine if the OI had an impact in AF recurrence, a multivariate binary logistic regression was performed.</p> <p><strong>Results: </strong>The population included 69.1% (n=112) males, 85.8% (n=139) paroxystic AF, mean age 54.9±11.0 years, and median CHA<sub>2</sub>DS<sub>2</sub>VASc=1. Immediate procedural success rate was obtained in 94.8% (568/599 veins). During follow-up, AF recurrence occurred in 19.8% (n=32) of patients. Left common trunk was present in 14.2% (n=23) and a right common trunk in 2.5% (n=4). The right superior PV (RSPV) ostium was the largest (mean area 297 mm2), and the left inferior PV (LIPV) was the smallest (mean area 172mm2). The most oval veins were usually the left superior PV (LSPV, mean OI 0,47) and the most round were the right inferior PV (RIPV, mean OI 0,16). The cut-off temperature was achieved in a total of 87,3% of veins. An OI > 0,30 was identified in 52.4% (n=314) of total veins. After multivariate analysis, the presence of an OI > 0,30 was an independent predictor for AF recurrence (OR=2,18 95CI 1,42-3,20, p=0,002).</p> <p><strong>Conclusion: </strong>Pulmonary vein ostial area and the presence of common trunks did not influence cryoballon isolation long-term success. However, the presence of oval veins (defined by an OI>0,30) was an independent predictor for AF recurrence. Thus, this trial demonstrates the impact of CT-evaluation of ostial PV morphology on clinical outcomes, and therefore this evaluation should be considered before cryoballoon PV isolation for AF treatment.</p>
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