Fluid overload and re-hospitalization following catheter ablation of long standing persistent atrial fibrillation: results from randomized study using a new irrigated catheter

Abstract

Catheter ablation 427 ral and spatial resolution is one of the most commonly used noninvasive tests for evaluation of pulmonary veins (PV) and adjacent structures before cryoablation of atrial fibrillation (AF). Identification of spatial neighboring of phrenic nerves is important to decrease likehood of phrenic nevre palsy (PNP). The purpose of our study is to clarify the course of the right phrenic nerve, its relations to PVs using 64-slice MDCT and impact on the occurrence of PNP. Method: A total of 162 patients underwent MDCT with 3-dimensional (3D) reconstruction of the left atrium (LA) prior to an cryoablation for AF. The location of the right pericardiophrenic artery (RPA) was identified on the axial images and the artery distance to the right upper pulmonary vein (RUPV) ostium was measured in the 3D image. Results: RPA was detectable in 145/162 (89.5%) patients (52.4% male, age 54.5±10.1 years and 80.7% paroxysmal AF). Acute procedural success rate was 96.2%. Mean procedural and fluoroscopy times were 74.4±6.2 min and 15.7±4.3 min. Transient right PNP was developed in 4 (2.75%) patients. RUPV ostium to RPA distance was higher in patients with PNP (p=0.033). In multivariate regression analysis, only RUPV ostium to RPA distance (OR: 2.95; 95% CI: 1.76-4.66, p: 0.001) was the independent predictor of PNP occurrence during cryoabla-tion. Conclusion: Our results revealed that pre-ablation cardiac imaging with 64-slice MDCT adequately detected the right pericardio-phrenic artery neighboring to phrenic nerve which was the important determinant of PNP development during cryoballoon based AF ablation.