Abstract 691 A novel saline-based occlusion tool allows for dye-less cryoballoon-based pulmonary vein isolation and fluoroscopy reduction

Background: Cryoballoon (CB)- based pulmonary vein isolation (PVI) remains guided by fluoroscopy and dye. The novel saline injection-based occlusion tool allows for pulmonary vein (PV)-occlusion assessment without the need for dye injection.

Aim: To compare KODEX-EPD guided CB-PVI using the novel saline injection-based workflow with conventional cryoablation for acute efficacy, fluoroscopy exposure and dye volume.

Methods: Consecutive atrial fibrillation (AF)- patients undergoing CB-PVI in conjunction with KODEX-EPD (Cryo^EPD group) were analyzed. A left atrial image was created to visualize pulmonary vein (PV) anatomy prior to ablation. PV-occlusion was assessed with the KODEX-EPD occlusion tool along with saline injection. Patients undergoing conventional CB-PVI (Cryo^CONV group) in the same time period acted as controls.

Results: One hundred forty patients (91/140 (65%) persistent AF) were studied. Seventy patients underwent Cryo^EPD procedures (64 ± 13 years, 21 (30%) female) and seventy patients underwent Cryo^CONV procedures (68 ± 10 years, 27 (39%) female).

A total of 560 PVs were identified and successfully isolated. Mean procedure time was 66 ± 15 minutes for the Cryo^EPD group, and 65 ± 19 minutes for the Cryo^CONV group (p=0.3). Fluoroscopy time (Cryo^EPD 6 ± 4 minutes; Cryo^CONV 13 ± 6 minutes, p<0.001) and dose area product (Cryo^EPD 193 [111; 297] cGycm²; Cryo^CONV 381 [268; 614] cGycm², p<0.001) were lower in patients undergoing Cryo^EPDcompared with Cryo^CONV procedures. No dye was needed in the Cryo^EPD group while 53 ± 18 ml dye per patient were administered for the Cryo^CONV group (p<0.001). The overall complication rate was comparable between both groups (p=0.5).

Conclusion: KODEX-EPD guided AF-ablation enables dye-free CB-based PVI with reduced fluoroscopy exposure when compared to conventional CB-ablation, without differences in acute procedural outcomes or procedure duration.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
A novel saline-based occlusion tool allows for dye-less cryoballoon-based pulmonary vein isolation and fluoroscopy reduction
L. Rottner¹, J. Obergassel¹, K. Borof¹, F. Moser¹, M. Lemoine², J. Wenzel¹, P. Kirchhof¹, F. Ouyang¹, B. Reißmann³, A. Metzner², A. Rillig²
¹Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; ²Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; ³Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg;
Background: Cryoballoon (CB)- based pulmonary vein isolation (PVI) remains guided by fluoroscopy and dye. The novel saline injection-based occlusion tool allows for pulmonary vein (PV)-occlusion assessment without the need for dye injection. Aim: To compare KODEX-EPD guided CB-PVI using the novel saline injection-based workflow with conventional cryoablation for acute efficacy, fluoroscopy exposure and dye volume. Methods: Consecutive atrial fibrillation (AF)- patients undergoing CB-PVI in conjunction with KODEX-EPD (Cryo^EPD group) were analyzed. A left atrial image was created to visualize pulmonary vein (PV) anatomy prior to ablation. PV-occlusion was assessed with the KODEX-EPD occlusion tool along with saline injection. Patients undergoing conventional CB-PVI (Cryo^CONV group) in the same time period acted as controls. Results: One hundred forty patients (91/140 (65%) persistent AF) were studied. Seventy patients underwent Cryo^EPD procedures (64 ± 13 years, 21 (30%) female) and seventy patients underwent Cryo^CONV procedures (68 ± 10 years, 27 (39%) female). A total of 560 PVs were identified and successfully isolated. Mean procedure time was 66 ± 15 minutes for the Cryo^EPD group, and 65 ± 19 minutes for the Cryo^CONV group (p=0.3). Fluoroscopy time (Cryo^EPD 6 ± 4 minutes; Cryo^CONV 13 ± 6 minutes, p<0.001) and dose area product (Cryo^EPD 193 [111; 297] cGycm²; Cryo^CONV 381 [268; 614] cGycm², p<0.001) were lower in patients undergoing Cryo^EPDcompared with Cryo^CONV procedures. No dye was needed in the Cryo^EPD group while 53 ± 18 ml dye per patient were administered for the Cryo^CONV group (p<0.001). The overall complication rate was comparable between both groups (p=0.5). Conclusion: KODEX-EPD guided AF-ablation enables dye-free CB-based PVI with reduced fluoroscopy exposure when compared to conventional CB-ablation, without differences in acute procedural outcomes or procedure duration.
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