Ablation lesion formation after PVI with cryoballoon versus CLOSE-guided RF ablation assessed by late gadolinium enhancement CMR

• Published in: European Heart Journal
• Main Authors: Regany, M, Pellicer, B, Borras, R, Ferro, E, Invers, E, Guichard, J B, Arbelo, E, Tolosana, J M, Porta, A, Roca, I, Guasch, E, Mont, L, Althoff, T F
• Format: Article in Journal/Newspaper
• Language: English
• Published: Oxford University Press (OUP) 2023
• Subjects: Cardiology and Cardiovascular Medicine; Arctic
• Online Access: http://dx.doi.org/10.1093/eurheartj/ehad655.526; https://academic.oup.com/eurheartj/article-pdf/44/Supplement_2/ehad655.526/53600424/ehad655.526.pdf

Abstract Background Durable pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Technological advances like ablation index-guided RF ablation and second generation cryoballoon have substantially improved lesion durability, but PV reconnection remains a key determinant of AF recurrences. Purpose We aimed to compare RF ablation following the CLOSE protocol and latest cryoballoon ablation regarding lesion continuity and durability using late gadolinium enhancement (LGE) CMR. Methods This study was based on a prospective registry in which all patients receive an LGE-CMR at 3 months after AF ablation. LGE-CMRs from consecutive patients that had undergone first-time PVI-only AF ablation, either by CLOSE-guided RF ablation (CLOSE) or cryo-ablation with the arctic front advance balloon (CRYO) were analysed. Gradient echo MR sequences were acquired in sinus rhythm and 3D-reconstruction of left atrium and PVs performed using ADAS-3D software. LGE was quantified based on the signal intensity ratio of each voxel relative to the blood pool, applying a previously validated threshold of >1.2 to define LGE indicative of ablation-induced scarring. LGE discontinuations of >3 mm were considered as gaps, and complete lesions were defined as LGE covering >90% of the peri-antral circumference of ipsilateral PV pairs. The analysis included an assessment of the average number of gaps around PV ostia, the normalized gap length, which was calculated as a percentage of the total gap length and the total PV perimeter. The ablation lesion width was also measured in millimetres. Results Post-ablation LGE-CMR from 87 patients were analysed - 40 patients in the CRYO group (70% paroxysmal AF), 47 in the CLOSE group (47% paroxysmal AF). The post-ablation LGE-lesions encircling ipsilateral PVs covered 74% (CRYO) and 75% (CLOSE) of the peri-antral circumference, obtaining no significant difference in the normalized gap length (26.23% vs 24.74%, p=0.7 ), as presented in figure 1c. Although ...