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.
