CL_I_P: Clinical Medicine I. Posters
Melinda Boussoussou MD 1, Borbála Vattay MD 1, Bálint Szilveszter MD 1, Márton Kolossváry MD1, Milán Vecsey-Nagy MD 1, Zoltán Salló MD 1, Judit Simon MD 2, Gábor Orbán MD 1, Perge Péter MD 1, Piros Katalin MD 1, Nagy Klaudia Vivien MD 1, Osztheimer István MD 1, Pál Maurovich-Horvat MD 2, Béla Merkely MD 1, László Gellér MD 1, Nándor Szegedi MD 1
1: Semmelweis University Heart and Vascular Center, 1122 Budapest, Városmajor utca 68., Hungary
2: Medical Imaging Centre, 1082 Budapest, Korányi Sándor u. 2., Hungary
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).
Semmelweis University, Doctoral School of Theoretical and Translational Medicine