PhD Scientific Days 2021

CL_I_P: Clinical Medicine I. Posters

The Role Of Left Atrial Wall Thickness And Pulmonary Vein Anatomy In Success Of Pulmonary Vein Isolation Using The Close Protocol.

Text of the abstract

Introduction: The CLOSE protocol is a novel contact-force guided technique for enclosing pulmonary veins in patients with atrial fibrillation (AF).
Aims: We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by coronary CT angiography (CTA), could influence the success-rate of first-pass isolation using the CLOSE protocol.
Methods: In a single-center, prospective study, we enrolled 94 consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation. Pre-procedural CTA was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained.
Results: A total of 94 patients were included in the analysis with a mean CHA2DS2-VASc score of 2.1±1.5 (mean age 62.4±12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2±19.3 minutes. Complete isolation of all four PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p≥0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR:1.00, p=0.04).
Conclusion: The CLOSE protocol in AF patients resulted in a high acute procedural success rate in terms of first-pass isolation, independently from the thickness of the LA wall. RSPV diameter could influence the probability of first-pass isolation.
Funding: EFOP-3.6.3-VEKOP-16-2017-00009, “NTP-NFTÖ” (Nemzeti Tehetség Program, Nemzet Fiatal Tehetségeiért Ösztöndíj) program of the Ministry of Human Capacities in Hungary (EMMI).

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine