Integration of left atrium (LA) images obtained by computer tomography or magnetic resonance reduces atrial fibrillation (AF) ablation procedural time because it enables a more accurate reconstruction of the anatomy (
Data included in our analysis was retrospectively collected from the start of AF ablation program in the University Hospital Centre Zagreb. In the beginning AF ablation program, 3D rotational angiography was utilized to depict LA anatomy and later on, we stopped using preprocedural imaging completely. A28 mm balloon was used via single transeptal puncture and a single 180 seconds freeze strategy was employed. We sought to compare procedural characteristics and outcomes of cryoballon ablation procedures done with the help of rotational angiography (RA arm) versus ablations performed without preprocedural imaging (non-RA). We have analyzed 117 successional second generation cryoballon procedures, 67 in RA group and 50 in non-RA group (74.3% male, 56.9±11.2 years). Paroxysmal AF was present in 78.6% of patients and early persistent in the rest. Mean left ventricle ejection fraction was 60.7±7.1% and mean left atrium diameter was 42.5±5.6 mm. The mean procedure times were significantly shorter for non-RA group (77.5±30.45 min) than RA group (125.3±40.8 min) (p <0.001). The mean fluoroscopy times was also shorter for non-RA group (12.9±7.9 min) than RA group (22.3±10.6 min) (p<0.001). Furthermore X –ray dosage and contrast expenditure were also significantly lower in non-RA group. X ray dosage was 1005.2±850 mGy vs 355.9±421.5 mGy (p <0.001) and contrast expenditure was 190.1±32.5 mL vs 85.2±22.1 mL for RA and nonRA group respectively. There were no significant differences in success rates and complications between groups. In our patient cohort, the use of rotational angiography significantly prolonged procedure times, X ray exposure and contrast expenditure. Superior procedural characteristic could be partly affected by growing operator’s experience. Omitting left atrium imaging did not influence the procedure safety and success rates. Preprocedural imaging is not mandatory for successful PVI but it may be useful to inexperienced operators and or in low volume centers.