Fluoroscopy and contrast media use in cryoballoon ablation of atrial fibrillation using a novel imaging system

Schillaci, Vincenzo; Stabile, Giuseppe; Arestia, Alberto; Shopova, Gergana; Agresta, Alessia; Poggi, Sara; Salita, Armando; Romano, C; Giannitti, Carlo Maria; Natalizia, Andrea; Simone, Antonio De; Solimene, Francesco

doi:10.1007/s00380-021-01902-2

Cited by 13 publications

(19 citation statements)

References 19 publications

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“…Schillaci et al ( 18 ) evaluated the impact of KODEX-EPD and the occlusion tool on procedural parameters, especially radiation and dye exposure, in a retrospective, single center study that enrolled 34 consecutive patients with paroxysmal AF. Here, 17 patients underwent a fluoroscopy-guided procedure while 17 patients underwent CB-PVI in combination with KODEX–EPD.…”

Section: Discussionmentioning

confidence: 99%

“…They found that overall procedure time was comparable between the two groups, and that fluoroscopy time and dye use were significantly lower in the KODEX–EPD group. At 12-month follow-up, no differences between the study groups regarding atrial arrhythmia recurrence were observed ( 18 ). Our data further underlines potential reductions in fluoroscopy time and dye usage in KODEX-EPD-guided CB-PVI.…”

Section: Discussionmentioning

confidence: 99%

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Cryoballoon ablation guided by a novel wide-band dielectric imaging system

Rottner¹,

Obergassel²,

My³

et al. 2022

Front. Cardiovasc. Med.

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Background and aimTo investigate the feasibility, acute efficacy, periprocedural safety, and procedural parameters of CB-based PVI guided by KODEX-EPD using different occlusion tool software versions.Methods and resultsA total of 173 patients (60/173 (35%) paroxysmal AF, 64 ± 12 years, 66/173 (38%) female), underwent CB-based PVI guided by KODEX-EPD between August 2019 and October 2021. Acute PVI was achieved in all the patients. Total fluoroscopy time and dye volume were 13.9 [10.6–19.4] min and 47.5 [20–70] ml. Periprocedural complications occurred in 3 (2%) of the 173 patients. As part of the continued development program, different software versions were used, including 1.4.6 on 38 (22%), 1.4.6a on 33 (19%), 1.4.7 on 41 (24%), and 1.4.8 on 61 (35%) of the patients. Outcomes were compared between software versions by a univariate analysis. Sensitivity analyses were performed to account for confounders. Median fluoroscopy time was decreased by 6.4 min (37.3%), and the median volume of dye was decreased by 32.5 ml (52%) from versions 1.4.6 to 1.4.8. Software version was a significant predictor of fluoroscopy time and dye volume, while reductions in procedure duration and dose area product were observed but mainly explained via confounders.ConclusionCB-based PVI guided by KODEX-EPD is feasible and safe. Progressive software improvements appear to be associated with lower fluoroscopy duration and dye use. Further studies are needed to evaluate the advantage of KODEX-EPD-guided compared to conventional CB-PVI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cryoballoon ablation guided by a novel wide-band dielectric imaging system

Rottner¹,

Obergassel²,

My³

et al. 2022

Front. Cardiovasc. Med.

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“…Despite the consequent use of the occlusion tool software in this study, we still performed a contrast-dye angiography of each PV before each freeze. Schillaci et al showed that a reduction in radiation exposure and dye use during CB ablation in patients with AF is possible (28). Further studies are necessary to demonstrate if the angiography can be omitted by the use of the occlusion tool.…”

Section: Discussionmentioning

confidence: 99%

Catheter Ablation in Complex Atrial Arrhythmias: Pilot Study Evaluating a 3D Wide-Band Dielectric Imaging System

Pongratz

Dorwarth

Riess

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCryoballoon ablation (CBA) for pulmonary vein isolation (PVI) is a standard in atrial fibrillation (AF) ablation but might not be enough in complex atrial arrhythmias (AA). An open three-dimensional wide-band dielectric imaging system (3D-WBDIS) has been introduced to guide CBA.Material and MethodsPilot study evaluating feasibility and safety of 3D-WBDIS in combination with CBA and optional radiofrequency ablation (RFA) in patients with complex AA defined as (1) history of persistent AF, (2) additional atrial tachycardia/flutter, or (3) previous left atrial ablation.ResultsProspectively, seventeen patients, 68.9 ± 12.2 years of age, with complex AA were enrolled. In 70 pulmonary veins (PV), balloon positioning maneuvers (n = 129) were guided additionally by the occlusion tool (1.84/PV). Compared to angiography, its sensitivity and specificity was 94.5, and 85%, respectively. CBA-PVI was achieved in 100% of PVs including variants. In 68 maps, the median number of mapping points was 251.0 (interquartile range (IQR) 298.0) with a median map volume of 52.8 (IQR 83.9) mL. Following CBA, six additional arrhythmias (two right and two left atrial flutter, one left atrial appendage tachycardia, and one atrioventricular nodal reentry tachycardia) were identified and successfully ablated by means of RFA in five patients (29.4%). Left atrial and fluoroscopy times were 88 (IQR 40) and 20 (IQR 10) minutes, respectively. Dose area product was 1,100 (IQR 1252) cGyxcm2. Freedom from AA after 6 months follow-up time and 90 days blanking period was documented in 10/17 (59%) patients, and 8/17 (47%) without a blanking period. No major complication was observed.ConclusionThe combined use of CBA with optional RFA guided by a novel 3D-WBDIS is feasible and safe in patients suffering from complex AA. The occlusion tool shows high sensitivity and specificity for assessment of the balloon occlusion. Additional arrhythmias were successfully mapped and ablated. Short-term outcome is promising, and subsequent prospective, larger outcome studies are necessary to confirm our observations.

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“…The KODEX‐EPD system (EPD Solutions, a Philips Company) is a novel 3‐dimentional navigation system, 7,8 which was shown to be feasible to reconstruct high‐resolution left atrial (LA) images, and to facilitate CBA procedure 9 . In addition, the occlusion verification software integrated in the system has recently been demonstrated to provide accurate and real‐time information of occlusion degree of CB, 10,11 thus significantly reduce contrast use and radiation exposure in CBA procedure 12 . In the latest version of this system, there are two tools, the baseline tool and the injection tool, available to facilitate the process of occlusion assessment.…”

Section: Introductionmentioning

confidence: 99%

Performance of two tools for pulmonary vein occlusion assessment with a novel navigation system in cryoballoon ablation procedure

Qiao

Zhao

et al. 2022

Cardiovasc electrophysiol

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Introduction Optimal occlusion of pulmonary vein (PV) is essential for atrial fibrillation (AF) cryoballoon ablation (CBA). The aim of the study was to investigate the performance of two different tools for the assessment of PV occlusion with a novel navigation system in CBA procedure. Methods In consecutive patients with paroxysmal AF who underwent CBA procedure with the guidance of the novel 3‐dimentional mapping system, the baseline tool, injection tool and pulmonary venography were all employed to assess the degree of PV occlusion, and the corresponding cryoablation parameters were recorded. Results In 23 patients (mean age 60.0 ± 13.9 years, 56.5% male), a total of 149 attempts of occlusion and 122 cryoablations in 92 PVs were performed. Using pulmonary venography as the gold standard, the overall sensitivity, specificity of the baseline tool was 96.7% (95% confidence interval [CI] 90.0%–99.1%), and 40.5% (95% CI 26.0%–56.7%), respectively, while the corresponding value of the injection tool was 69.6% (95% CI 59.7%–78.1%), and 100.0% (95% CI 90.6%–100.0%), respectively. Cryoablation with optimal occlusion showed lower nadir temperature (baseline tool: −44.3 ± 8.4°C vs. −35.1 ± 6.5°C, p < .001; injection tool: −46.7 ± 6.4°C vs. −38.3 ± 9.2°C, p < .001) and longer total thaw time (baseline tool: 53.3 ± 17.0 s vs. 38.2 ± 14.9 s, p = .003; injection tool: 58.5 ± 15.5 s vs. 41.7 ± 15.2 s, p < .001) compared with those without. Conclusions Both tools were able to accurately assess the degree of PV occlusion and predict the acute cryoablation effect, with the baseline tool being more sensitive and the injection tool more specific.

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Fluoroscopy and contrast media use in cryoballoon ablation of atrial fibrillation using a novel imaging system

Cited by 13 publications

References 19 publications

Cryoballoon ablation guided by a novel wide-band dielectric imaging system

Cryoballoon ablation guided by a novel wide-band dielectric imaging system

Catheter Ablation in Complex Atrial Arrhythmias: Pilot Study Evaluating a 3D Wide-Band Dielectric Imaging System

Performance of two tools for pulmonary vein occlusion assessment with a novel navigation system in cryoballoon ablation procedure

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