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Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation
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Intra-Procedural Three-Dimensional Rotational Angiography in Cryoballoon Ablation of Atrial Fibrillation: An RCT.

Ivan Prepolec1,2, Vedran Pašara1,2, Andrija Nekić1

  • 1Department For Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia.

Pacing and Clinical Electrophysiology : PACE
|March 16, 2026
PubMed
Summary

Three-dimensional rotational angiography (3DRA) did not improve atrial fibrillation (AF) cryoballoon ablation success rates. This imaging technique increased procedure time, radiation exposure, and contrast media usage without enhancing long-term outcomes.

Keywords:
atrial fibrillationcardiac imagingcryoballoon ablationpulmonary vein isolationthree‐dimensional rotational angiography

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • The effectiveness of imaging modalities in atrial fibrillation (AF) ablation is not fully understood.
  • Intra-procedural three-dimensional rotational angiography (3DRA) is underutilized despite potential advantages.
  • This study evaluates 3DRA's impact on cryoballoon (CB) ablation outcomes.

Purpose of the Study:

  • To assess the impact of 3DRA on procedural success, safety, and long-term outcomes in cryoballoon ablation for AF.
  • To compare outcomes between patients undergoing CB ablation with and without 3DRA guidance.

Main Methods:

  • A single-center, unblinded, randomized controlled trial involving 134 patients with AF.
  • Patients were randomized to either standard care (no imaging) or 3DRA-guided cryoballoon ablation.
  • Follow-up was conducted for 12 months to assess AF recurrence.

Main Results:

  • No significant difference in pulmonary vein isolation success between groups (4.5% vs. 2.9%, p=0.636).
  • 3DRA group had longer procedure times (86.7 vs. 67.2 min, p<0.001), higher radiation dose (447.4 vs. 133.9 mGy, p<0.001), and increased contrast use (131.8 vs. 40.8 mL, p<0.001).
  • AF freedom at 12 months was similar: 86.2% in the 3DRA group vs. 88.2% in the control group (p=0.798).

Conclusions:

  • 3DRA does not enhance procedural success or long-term efficacy of cryoballoon ablation for AF.
  • 3DRA significantly increases procedure duration, radiation exposure, and contrast agent consumption.
  • Current evidence suggests 3DRA is not beneficial for routine use in CB ablation.