Abstract 141 Accuracy and acute efficacy of the novel injection-based occlusion algorithm in cryoballoon pulmonary vein isolation guided by dielectric imaging

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Accuracy and acute efficacy of the novel injection-based occlusion algorithm in cryoballoon pulmonary vein isolation guided by dielectric imaging
L. Rottner¹, F. Moser¹, R. Schleberger², J. Weimann¹, J. Moser², M. Lemoine², P. Münkler², L. Dinshaw², T. Risius³, P. Kirchhof¹, F. Ouyang⁴, B. Reissmann¹, A. Metzner², A. Rillig²
¹Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; ²Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; ³Kardiologische Praxis Orchideenstieg, Hamburg; ⁴Kardiologie, Asklepios Klinik St. Georg, Hamburg;
Background: Cryoballoon (CB)-based pulmonary vein isolation (PVI) currently requires occlusion assessment of each pulmonary vein (PV) using fluoroscopy and dye injection. Objective: This study evaluated, whether the novel KODEX-EPD (EPD Solutions, Philips, Netherlands) occlusion tool reliably verifies PV-occlusion according to a novel dye-injection based algorithm. Methods: A total of 75 patients suffering from AF, who underwent CB-based PVI, were analyzed. Feasibility, acute efficacy, procedure duration and radiation exposure were evaluated for patients in whom KODEX-EPD and its occlusion tool were applied (n=50, EPD-group) and compared to a control group of patients undergoing conventional CB-based PVI (n=25, conventional cryoablation-group). To accurately visualize PV anatomy, selective PV-angiographies were performed in the first half of the patients of the EPD-group (EPD-group A) in addition to a 3D left atrial (LA) KODEX-EPD-based imaging using a spiral mapping catheter (Achieve, SMC1, Medtronic, MN, USA). PV-angiographies were waived in the following patients (EPD-group B). PV-occlusion was confirmed via fluoroscopy in all patients of the EPD-group to validate the accuracy of the novel occlusion tool. Results: CB-based PVI was successful in 50/50 patients of the EPD-group (mean age 63±11 years, 31 (62%) male, 18 paroxysmal (36%), LA diameter 43±7 mm) and in 25/25 patients of the conventional cryoablation-group (66±10 years, 19 (76%) male, 9 paroxysmal (36%), LA diameter 41±6 mm). In the final evaluation phase (EPD-group B) LA fluoroscopy times and dose area products were comparable to the conventional cryoablation-group (10.5±5 vs 8.8±4 minutes; p=0.23 and 403±425 vs 321±202 cGycm²; p=0.44), while the amount of dye was significantly reduced (EPD-group B: 31±18 ml vs conventional cryoablation-group: 50±20 ml, p<0.0001). Concordance of PV-occlusion angiography with the KODEX-EPD injection-workflow was documented in 237/272 (87%) occlusion-analyses among 198 PVs. Conclusion: The novel KODEX-EPD occlusion tool allows for accurate PV-occlusion assessment without additional fluoroscopic verification in the majority of PVs and CB-based PVI in conjunction with KODEX-EPD is accompanied with high acute ablation success rates.
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