Assessing the value of routine preprocedural CT angiography in cryoballoon pulmonary vein isolation: a prospective, propensity score-matched study.

Background: We aimed to evaluate the impact of routine preprocedural left atrial and coronary computed tomography angiography (CTA) on procedural strategies and clinical outcomes in patients undergoing cryoballoon pulmonary vein isolation (PVI). Methods: In this prospective, propensity score-matched study, we analyzed patients who underwent cryoballoon PVI at our institution between January 2019 and March 2023. Patients were assigned to either a CTA group, where preprocedural CTA was performed, or a control group, where PVI was guided by fluoroscopy alone. To minimize selection bias, 1:1 propensity score matching (PSM) was applied based on baseline characteristics, including age, sex, left atrial diameter, BMI, and AF type. Coronary artery disease (CAD) was assessed in the CTA group, and three-dimensional left atrial reconstruction images assisted the operator during the procedure. Results: After PSM, 320 patients (160 per group) were included in the final analysis. Procedural time was comparable between the CTA and control groups (52 ± 13 min vs. 51 ± 15 min, p = 0.36), as was left atrial dwell time (39.9 ± 11 min vs. 40.5 ± 13 min, p = 0.63). Acute pulmonary vein isolation rates (96 % vs. 92 %, p = 0.23) and 12-month arrhythmia-free survival (CTA: 75 % vs. control: 75.6 %, p = 0.90) did not significantly differ. However, previously undiagnosed CAD was identified in 84 patients (52.5 %) in the CTA group, leading to 23 (27.4 %) referrals for invasive coronary angiography. Conclusions: Routine preprocedural CTA did not significantly impact procedural efficiency or clinical outcomes in cryoballoon PVI. However, the high prevalence of previously undiagnosed CAD underscores the potential value of coronary assessment in this population.