Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Radiofrequency-based pulmonary vein isolation guided exclusively by a 3-D wide-band dielectric imaging: Feasibility and procedural details
F. Moser1, L. Rottner1, J. Moser2, R. Schleberger2, P. Münkler2, L. Dinshaw2, M. Lemoine2, I. My3, P. Kirchhof1, B. Reißmann1, F. Ouyang1, 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; 3Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH, Hamburg;
Background: 
Recently, a novel wide-band dielectric imaging system (KODEX-EPD) was introduced. First clinical experience has shown accurate visualization of the left atrium and the feasibility to guide radiofrequency (RF)-based Pulmonary vein isolation (PVI) compared to simultaneously used mapping systems.


Aim:  
We report procedural details and outcomes of RF-based PVI guided exclusively by the novel wide-band dielectric imaging system. 


Methods: 
Consecutive patients with AF who underwent RF-based PVI guided exclusively by the KODEX-EPD system were evaluated. The 3-D images were created with a spiral mapping catheter either in AF or in sinus rhythm, circumferential isolation of the ipsilateral pulmonary veins (PVs) was performed via point-by-point RF ablation.


Results: 
A total of 17 patients (10 male (59%), 66±11 years, 5 persistent AF (29%)) underwent RF-based PVI with KODEX EPD guidance. The total procedure time was 134 [119, 149] minutes, fluoroscopy time and dosage were 15 [14, 18] minutes and 492 [366, 575] cGycm, respectively. KODEX-EPD map of the left atrium was obtained with a mean of 2012 [1105, 2297] acquired mapping points within 13 [8, 17] minutes. One patient had a left common ostium. All 67 PVs (100%) were successfully isolated with 18 [14, 24] RF applications for the right PVs and 17 [16, 20] RF applications for the left PVs. In one patient cardioversion could not restore SR after PVI only, therefore a left atrial anterior line and posterior box ablation was successfully applied. One cardiac tamponade occurred and one transient ST-elevation for <10 min was observed.


Conclusion: 
RF-based isolation pulmonary vein isolation guided exclusively by the KODEX-EPD system is feasible. Larger studies are needed to compare the KODEX-EPD imaging system with established 3D-mapping systems.
https://dgk.org/kongress_programme/jt2022/aP1175.html