Analysis of the anatomical features of pulmonary veins on pre-procedural cardiac CT images resulting in incomplete cryoballoon ablation for atrial fibrillation.
Adult
Aged
Aged, 80 and over
Atrial Fibrillation
/ diagnostic imaging
Computed Tomography Angiography
Coronary Angiography
/ methods
Cryosurgery
/ adverse effects
Female
Humans
Male
Middle Aged
Multidetector Computed Tomography
Predictive Value of Tests
Pulmonary Veins
/ diagnostic imaging
Recurrence
Retrospective Studies
Risk Factors
Treatment Failure
Anatomical features
Atrial fibrillation
Cardiac computed tomography
Cryoballoon ablation
Pulmonary vein
Journal
Journal of cardiovascular computed tomography
ISSN: 1876-861X
Titre abrégé: J Cardiovasc Comput Tomogr
Pays: United States
ID NLM: 101308347
Informations de publication
Date de publication:
Historique:
received:
19
06
2018
revised:
20
09
2018
accepted:
11
11
2018
pubmed:
24
11
2018
medline:
14
6
2019
entrez:
24
11
2018
Statut:
ppublish
Résumé
To investigate the anatomical features related to the failure of cryoballoon (CB) ablation for atrial fibrillation (AF) on pre-procedural CT images. We retrospectively analyzed CT images of 100 patients with AF who had undergone a first CB ablation at our institution between June 2016 and April 2017. We measured the angle, short- and long axis length, and the area and ovality of 4 major pulmonary vein (PV) ostium on CT images. We performed logistic regression analysis to analyze the anatomical features related to the failure (incomplete CB ablation) of PV isolation. We also performed a receiver-operating characteristic (ROC) curve analysis to identify an appropriate cut-off value for anatomical features significantly associated with incomplete CB ablation. We analyzed 400 PVs in 100 patients [aged 64 (range, 27-82) years, 59% male]. The rate of incomplete CB ablation was significantly higher for right-than left-sided PVs (p < 0.001). The anatomical feature significantly associated with incomplete CB ablation was the angle at the right inferior PV (RIPV) (AOR: 1.17; 95% CI: 1.09-1.27, p < 0.001) and the right superior PV (RSPV) (AOR: 1.12; 95% CI: 1.01-1.23; p = 0.014). In the ROC analysis, the optimal cut-off value for RIPV and RSPV angle to discriminate an incomplete CB ablation were 40.1° and 79.7°, respectively. Our findings may help to select the appropriate ablation strategy to treat patients with AF. We show that the angle is an anatomical feature significantly related to failed CB ablation.
Sections du résumé
BACKGROUND
BACKGROUND
To investigate the anatomical features related to the failure of cryoballoon (CB) ablation for atrial fibrillation (AF) on pre-procedural CT images.
METHODS
METHODS
We retrospectively analyzed CT images of 100 patients with AF who had undergone a first CB ablation at our institution between June 2016 and April 2017. We measured the angle, short- and long axis length, and the area and ovality of 4 major pulmonary vein (PV) ostium on CT images. We performed logistic regression analysis to analyze the anatomical features related to the failure (incomplete CB ablation) of PV isolation. We also performed a receiver-operating characteristic (ROC) curve analysis to identify an appropriate cut-off value for anatomical features significantly associated with incomplete CB ablation.
RESULTS
RESULTS
We analyzed 400 PVs in 100 patients [aged 64 (range, 27-82) years, 59% male]. The rate of incomplete CB ablation was significantly higher for right-than left-sided PVs (p < 0.001). The anatomical feature significantly associated with incomplete CB ablation was the angle at the right inferior PV (RIPV) (AOR: 1.17; 95% CI: 1.09-1.27, p < 0.001) and the right superior PV (RSPV) (AOR: 1.12; 95% CI: 1.01-1.23; p = 0.014). In the ROC analysis, the optimal cut-off value for RIPV and RSPV angle to discriminate an incomplete CB ablation were 40.1° and 79.7°, respectively.
CONCLUSION
CONCLUSIONS
Our findings may help to select the appropriate ablation strategy to treat patients with AF. We show that the angle is an anatomical feature significantly related to failed CB ablation.
Identifiants
pubmed: 30466810
pii: S1934-5925(18)30208-9
doi: 10.1016/j.jcct.2018.11.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
118-127Informations de copyright
Copyright © 2019 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.