Utility of Routine Pulmonary Angiography Prior to Ablation of Atrial Fibrillation : a Controlled Randomized Study

Various imaging modalities are used during radiofrequency ablation (RFA) of atrial fibrillation (AF) with electroanatomic mapping (EM) under the assumption that this improves outcomes. However, the utility of routine imaging in AF ablation has not been well studied. Seventy-one patients undergoing irrigated tip RFA of AF were randomized to pulmonary venography or no imaging during ablation. EM was used to reconstruct the left atrium prior to ablation. Rhythm monitoring at 4–6 months was used to compare results. Baseline characteristics were similar in both groups. Contrast dose for patients undergoing venography was 44¡14 ml. Procedure times (294¡91 versus 271¡109 min, p50.33) and fluoroscopy times were not statistically longer (55¡16 versus 49¡11 min, p50.10) in patients undergoing venography. Creatinine prior to and post procedure was unchanged for both groups. There was one cardiac tamponade in the group without venography, and one episode of acute renal injury and an anomalous right inferior pulmonary vein (PV) in the venography group. Forty-five of 66 monitored patients (68%) were arrhythmia free on follow-up, with no difference between groups (63% versus 74%, p50.43). There is no significant improvement in procedural efficiency or success rates with pulmonary venography during AF ablation. This may be due to the ability of EM to define PV anatomy and the limited need for precise PV localization with circumferential ablation techniques well beyond the PV ostia.