Ullrich Ebersberger MD, Presenter: Nothing to Disclose

Michael Bernard, Abstract Co-Author: Nothing to Disclose

U. Joseph Schoepf MD, Abstract Co-Author: Research Grant, Bracco Group Research Grant, Bayer AG Research Grant, General Electric Company Research Grant, Siemens AG

Andrew Douglas McQuiston BS, Abstract Co-Author: Nothing to Disclose

John Wharton, Abstract Co-Author: Nothing to Disclose

William Wince, Abstract Co-Author: Nothing to Disclose

James Cranston Gray BA, Abstract Co-Author: Nothing to Disclose

Justin R. Silverman, Abstract Co-Author: Nothing to Disclose

Lucas L. Geyer MD, Abstract Co-Author: Speaker, General Electric Company

Yining Wang MD, Abstract Co-Author: Nothing to Disclose

Philipp Blanke MD, Abstract Co-Author: Nothing to Disclose

Ellen Hoffmann, Abstract Co-Author: Nothing to Disclose

Recent studies report decreased procedural success in ablation therapy of atrial fibrillation (AF) when cryoballoon ablation is applied to pulmonary vein (PV) ostia with an overly non-circular, oval shape. We used cardiac CT data of a large patient cohort to evaluate whether this also holds true for an approach using wide circumferential radiofrequency ablation (WACA). 

We evaluated data of 260 patients with AF who had undergone WACA. All patients routinely underwent 30 day holter-ECG to assess procedural success as well as cardiac dual-source CT to exclude post-procedural complications. PV measurements were performed in a plane perpendicular to the center-line of each PV at 10mm from the junction of the PV and the left atrium. The ovality index was calculated for all PVs and was defined as follows: 2x (maximal diameter-minimal diameter)/(maximal diameter+minimal diameter).

The minimal index of ovality in patients with AF recurrence was 0.20±0.10 for the left superior PV (LSPV), 0.23±0.14 for the left inferior PV (LIPV), 0.19±0.10 for the right superior PV (RSPV), and 0.17±0.10 for the right inferior PV (RIPV). In successfully treated patients without recurrence of AF the minimal ovality index was 0.20±0.16 for LSPV, 0.27±0.16 for LIPV, 0.19±0.11 for RSPV, and 0.18±0.12 for RIPV. The maximal index of ovality was 0.43±0.19 for LSPV, 0.47±0.20 for LIPV, 0.40±0.15 for RSPV, and 0.41±0.15 for RIPV for patients with no AF recurrence. For patients with recurrence of AF the maximal ovality index was 0.43±0.14 for LSPV, 0.45±0.17 for LIPV, 0.40±0.14 for RSPV, and 0.42±0.17 for RIPV. There were no significant differences in the minimal or maximal ovality indices between the two patient groups (p>0.05).

While previous studies have described an important impact of PV ovality on clinical outcome after cryoballoon ablation, we did not find a significant influence of the PV ovality index on ablation success when using WACA as the ablation strategy. Accordingly, the ovality index may aid in selecting the most promising ablation technique for the individual patient's anatomy.

Pre-procedural assessment of the PV ovality index might serve to guide the selection of an individualized ablation approach that maximizes the chances for therapeutic success.

Ebersberger, U, Bernard, M, Schoepf, U, McQuiston, A, Wharton, J, Wince, W, Gray, J, Silverman, J, Geyer, L, Wang, Y, Blanke, P, Hoffmann, E, Cardiac CT in Atrial Fibrillation Therapy: Using the Pulmonary Vein Ovality Index for Selecting Ablation Technique.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011235.html