Novel dyeless and fluoro-less approach to cryoballoon pulmonary vein occlusion assessment

Avitall, Boaz; Kalinski, Arthur; Kocheril, G. Stephen; Laske, Timothy G.; Coulombe, Nicolas

doi:10.1016/j.hrthm.2017.05.004

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…Other researchers also implemented NC protocols for CBA, however with the use of other measures to assess PV occlusion prior to the cryoapplication, which included transesophageal or intracardiac echocardiography guidance, electroanatomic mapping systems, PV pressure monitoring, cold saline injection with postinjection PV temperature drop [11][12][13][14][15][16][17]. Recently a new dielectric imaging system with a tool occlusion software allowing contrast free cryoablations has been introduced with a potential to change our approach to cryoablation [18,19].…”

Section: Discussionmentioning

confidence: 99%

Cryoballoon ablation without use of contrast for the treatment of paroxysmal atrial fibrillation

Derejko,

Kuśnierz,

Bardyszewski

et al. 2024

Cardiol J.

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Background: Cryoballoon ablation (CBA) for atrial fibrillation (AF) is usually preceded by demonstrating pulmonary vein (PV) occlusion using contrast. The aim of the study was to determine efficacy and safety of a simplified protocol for CBA performed without demonstrating PV occlusion and compare achieved results with conventional CBA. Methods: Paroxysmal AF patients undergoing a first-time CBA were prospectively included. In the non-contrast (NC) group CBA was performed using standardized protocol without demonstrating PV occlusion. In the conventional contrast (CC) group ablations were performed after confirmation of PV occlusion. Results:The NC and CC groups comprised 51 and 22 patients, respectively. PVI according to the group assignment was achieved in 34 (67%) and 21 (95.5%) patients from the NC and CC groups, respectively (p < 0.001). In the NC group, 184 (90%) out of 204 veins were isolated without venography. There were no differences between the NC and CC groups in terms of procedure duration

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Section: Discussionmentioning

confidence: 99%

Cryoballoon ablation without use of contrast for the treatment of paroxysmal atrial fibrillation

Derejko,

Kuśnierz,

Bardyszewski

et al. 2024

Cardiol J.

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“…Avitall et al . 23 reported in their animal study that good PV occlusion could be discriminated by a marked temperature drop and slow rewarming after injecting 5 cc cold saline at 4°C into the PV, which was assessed based on pre-specified images created by a 3D navigation system. Kühne et al .…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of intracardiac echocardiography–guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial

et al. 2023

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Aims The development of intracardiac echocardiography (ICE) has enabled fluoroless atrial fibrillation (AF) ablation using three-dimensional electroanatomical mapping systems. However, fluoroless cryoballoon ablation (CBA) remains challenging, mainly because of the lack of a visual mapping system. Hence, this study aimed to investigate the safety and efficacy of fluoroless CBA for AF under ICE guidance. Methods and results Patients (n = 100) who underwent CBA for paroxysmal AF were randomly assigned to zero-fluoroscopic (Zero-X) and conventional groups. Intracardiac echocardiography was used to guide the transseptal puncture and catheter and balloon manipulation in all enrolled patients. The patients were prospectively followed for 12 months after CBA. The mean age was 60.4 years, and the left atrial (LA) size was 39.4 mm. Pulmonary vein isolation (PVI) was achieved in all patients. In the Zero-X group, fluoroscopy was used in only one patient because of unstable phrenic nerve capture during right-sided PVI. The procedure time and LA indwelling time in the Zero-X group were not statistically different compared with that in the conventional group. Fluoroscopic time (9.0 vs. 0.008 min) and radiation exposure (29.4 vs. 0.02 mGy) were significantly shorter in the Zero-X group than in the conventional group (P < 0.001). The complication rate did not differ between the two groups. During a mean follow-up of 663.3 ± 172.3 days, the recurrence rate was similar (16.0 vs. 18.0%; P = 0.841) between the groups. Multivariate analysis revealed that LA size was the only independent predictor of clinical recurrence. Conclusion Intracardiac echocardiography–guided fluoroless CBA for AF was a feasible strategy without compromising acute and long-term success or complication rates.

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“…Although alternative means to demonstrate PV occlusion by measuring pressures ( 16 , 17 ) or using transesophageal echocardiography ( 18 ) have been reported, they are not practical and are not used in clinical routine. A study by Avitall et al showed in canines that PV occlusion can be determined by cold saline injection but the technique has not been tested in humans ( 19 ). All these approaches have in common that testing for and demonstrating PV occlusion is considered necessary in any case before performing successful CB ablation at a given PV.…”

Section: Discussionmentioning

confidence: 99%

Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion—The Simplify Cryo Study

Kühne

Knecht

Spies

et al. 2021

Front. Cardiovasc. Med.

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Background: The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion.Methods and Results: Consecutive patients undergoing CB pulmonary vein isolation (PVI) were studied. After cMRI assessment, patients treated by PVI using a novel no-contrast (NC) protocol without routine contrast injections to demonstrate PV occlusion (NC group) were compared to patients undergoing PVI with contrast injections to demonstrate PV occlusion (standard group). One hundred patients with paroxysmal or persistent AF (age 61 ± 10 years, ejection fraction 59 ± 11%, left atrial volume index 37.2 ± 2.0 mL/m2) were studied. The NC protocol was feasible in 72 of 75 patients (96%). Total procedure time and fluoroscopy time were 64.0 ± 14.1 min and 11.0 ± 4.6 min in the NC group and 92.0 ± 25.3 min and 18.0 ± 6.0 min in the standard group, respectively (all p < 0.001). Dose area product was 368 ± 362 cGy*cm2 in the NC group compared to 1928 ± 1541 cGy*cm2 in the standard group (p < 0.001). Forty-five of 75 patients (60%) in the NC group and 16 of 25 patients (64%) in the standard group remained in stable sinus rhythm after a single PVI and a 1-year follow-up (p = 0.815).Conclusions: Performing CB ablation without using contrast injections to demonstrate PV occlusion was feasible, resulted in reduced radiation exposure, and increased the efficiency of the procedure.

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Novel dyeless and fluoro-less approach to cryoballoon pulmonary vein occlusion assessment

Cited by 6 publications

References 6 publications

Cryoballoon ablation without use of contrast for the treatment of paroxysmal atrial fibrillation

Cryoballoon ablation without use of contrast for the treatment of paroxysmal atrial fibrillation

Safety and efficacy of intracardiac echocardiography–guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial

Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion—The Simplify Cryo Study

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