The role of left atrial wall thickness and pulmonary vein anatomy in success of pulmonary vein isolation using the CLOSE protocol

Abstract Introduction The CLOSE protocol is a novel contact-force guided technique for enclosing pulmonary veins in patients with atrial fibrillation (AF). Consistency and lesion contiguity are essential factors procedural success. We sought to determine whether left (LA) wall thickness (LAWT) vein (PV) dimensions as assessed by coronary CT angiography (CTA) could influence the efficacy of successful first-pass isolation using protocol. Methods In single center, prospective study we enrolled 94 symptomatic, drug-refractory AF who underwent pre-ablation CTA initial radiofrequency catheter ablation between 2019.01–2020.09. LA was divided into 11 regions when assessing LAWT. Additionally, diameter area PV orifices were obtained. First pass recorded separately right PVs. After first circles ready, additional ablations applied those cases where not achieved, reach complete isolation. Predictors determined logistic regression models that included anthropometrical, echocardiographic derived parameters. Results A total analysis mean CHA2DS2-VASc score 2.1±1.5 (mean age 62.4±12.6 years, 39.5% female). 61.7% paroxysmal, 38.3 persistent patients. Mean procedure times 81.2±19.3 minutes. Complete all four PVs achieved 100% First-pass rate 76%, 71% 54%, PVs, respectively. No difference found regarding comorbidities imaging parameters without LAWT or separately) had no effect on outcome (all p>0.05). Out parameters, only RSPV associated sided PVI (p=0.04, OR 1.01). Conclusion use resulted high periprocedural success terms isolation, independently from wall. results Funding Acknowledgement Type funding sources: None.