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Analysis of the anatomical features of pulmonary veins on pre-procedural cardiac CT images resulting in incomplete cryoballoon ablation for atrial fibrillation |
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| Institution: | 1. Department of Radiological Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan;2. Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan;3. Department of Cardiology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan;4. Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan;5. Department of Radiology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Naka-ku, Hiroshima, 730-8655, Japan;6. Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan;2. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan;3. Johnson & Johnson, Biosense Webster, Inc., Diamond Bar, California;1. Department of Radiology, People''s Hospital, Peking University, Beijing, 100044, China;2. Department of Cardiac, People''s Hospital, Peking University, Beijing, 100044, China;1. Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA;2. Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA;1. Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA;2. Department of Radiology, Mayo Clinic, Rochester, MN, USA;3. Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA;4. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA;5. Capitol Cardiology Associates, Albany, NY, USA;6. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany;7. Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany;8. King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia;9. Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA;10. Department of Nuclear Medicine, University Hospital, Zurich, Switzerland and University of Zurich, Switzerland;11. Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA;12. Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy;13. Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy;14. Cardiology Service, Walter Reed National Military Center, Bethesda, MD, USA;15. Seoul National University Hospital, Seoul, South Korea;p. Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada;q. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria;r. Centro Cardiologico Monzino, IRCCS Milan, Italy;s. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal;t. Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel;u. Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany;v. Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea;w. Department of Medicine and Radiology, University of Ottawa, ON, Canada;x. Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA;y. Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA;z. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands |
| Abstract: | BackgroundTo investigate the anatomical features related to the failure of cryoballoon (CB) ablation for atrial fibrillation (AF) on pre-procedural CT images.MethodsWe 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.ResultsWe 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.ConclusionOur 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. |
| Keywords: | Cardiac computed tomography Atrial fibrillation Cryoballoon ablation Pulmonary vein Anatomical features AF"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"Atrial fibrillation AOR"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"adjusted odds ratio AUC"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"area under the curve CB"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"cryoballoon CI"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"confidence interval CNR"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"contrast-to-noise ratio FOV"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"field of view HU"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"Hounsfield Units LA"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"left atrium LAA"} {"#name":"keyword" "$":{"id":"kwrd0130"} "$$":[{"#name":"text" "_":"left atrial appendage LIPV"} {"#name":"keyword" "$":{"id":"kwrd0140"} "$$":[{"#name":"text" "_":"left inferior pulmonary vein LSPV"} {"#name":"keyword" "$":{"id":"kwrd0150"} "$$":[{"#name":"text" "_":"left superior pulmonary vein LV"} {"#name":"keyword" "$":{"id":"kwrd0160"} "$$":[{"#name":"text" "_":"left ventricle MPR"} {"#name":"keyword" "$":{"id":"kwrd0170"} "$$":[{"#name":"text" "_":"multiplanar reconstruction PV"} {"#name":"keyword" "$":{"id":"kwrd0180"} "$$":[{"#name":"text" "_":"pulmonary vein RA"} {"#name":"keyword" "$":{"id":"kwrd0190"} "$$":[{"#name":"text" "_":"right atrium RF"} {"#name":"keyword" "$":{"id":"kwrd0200"} "$$":[{"#name":"text" "_":"radiofrequency RIPV"} {"#name":"keyword" "$":{"id":"kwrd0210"} "$$":[{"#name":"text" "_":"right inferior pulmonary vein ROC"} {"#name":"keyword" "$":{"id":"kwrd0220"} "$$":[{"#name":"text" "_":"receiver-operating characteristic ROI"} {"#name":"keyword" "$":{"id":"kwrd0230"} "$$":[{"#name":"text" "_":"region of interest RSPV"} {"#name":"keyword" "$":{"id":"kwrd0240"} "$$":[{"#name":"text" "_":"right superior pulmonary vein SD"} {"#name":"keyword" "$":{"id":"kwrd0250"} "$$":[{"#name":"text" "_":"standard deviation 3D"} {"#name":"keyword" "$":{"id":"kwrd0260"} "$$":[{"#name":"text" "_":"3-dimensional |
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