Impact of preprocedural imaging on outcomes of single-shot pulmonary vein isolation: a retrospective propensity score matched study
N Soubh, B Hasan, E Rasenack, H Haarmann, F Wiedmann, M Zabel, C Schmidt, L BergauAbstract
Introduction
Single-shot pulmonary vein isolation (ssPVI) using cryoballoon ablation (CBA) or pulsed field ablation (PFA) is an established, effective, and safe therapy for patients with atrial fibrillation (AF). Preprocedural imaging (preIMG) with cardiac computed tomography (CT) or magnetic resonance imaging (MRI) is commonly used to assess pulmonary vein (PV) anatomy. This study aimed to evaluate the impact of preIMG on procedural parameters, safety, and effectiveness of ssPVI.
Methods
We performed a retrospective analysis of all AF patients who underwent index ssPVI using either the cryoablation or pentaspline PFA system at our center between 01.06.2022 and 30.12.2024. Procedural and imaging data were analyzed. Major complications were defined as death, stroke or transient ischemic attack (TIA), atrial-esophageal fistula, cardiac tamponade, or vascular complications requiring surgical intervention All patients were scheduled for follow-up at six months post-ablation. To minimize baseline confounding, 1:1 nearest-neighbor propensity score matching was performed using AF type and ablation modality. Continuous and categorical variables were compared using the Mann–Whitney U and Fisher’s exact tests, respectively. Time-to-event analyses for symptomatic atrial arrhythmia recurrence were conducted using Kaplan–Meier estimates with log-rank testing. Statistical significance was set at p<0.05. Analyses were conducted in RStudio (V. 2025.09.0).
Results
A total of 303 patients were included, of whom 147 (48.5%) underwent preIMG and 156 (51.5%) underwent ablation without preIMG. The baseline characteristics of the 1:1 matched cohort (n = 186; 93 per group) are shown in Table 1. Patients with preIMG had significantly longer hospital stays and higher contrast agent exposure (both p<0.001). Other intraprocedural parameters did not differ significantly between groups (Table 2). Two major complications occurred in the preIMG group (TIA and femoral artery pseudoaneurysm), whereas none occurred in the non-preIMG group (p=0.497). Atypical PV anatomy was identified in 36 patients (24%), and incidental findings requiring urgent evaluation or treatment were found in 24 patients (16%). Mid-term arrhythmia-free survival at nine months was comparable between groups (82% vs. 79%, log-rank p=0.438) (Figure 1). The arrhythmia-free survival in the general unmatched cohort at 9 months was not significantly affected by the choice of ablation method (72% vs. 75% in PFA and CBA respectively, log-rank p=0.587).
Conclusions
In this single-center retrospective study, omitting preprocedural imaging was associated with reduced contrast exposure and shorter hospital stays, while procedural performance, safety, and mid-term effectiveness were comparable to ssPVI performed with preIMG. Fluoroscopic guidance alone may be sufficient to achieve effective PVI using current single-shot ablation systems.Tables 1 and 2Figure 1