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

Abstract

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.

Occlusion and catheter ablation using a large-size cryoballoon for various pulmonary veins: a case series

“…Effective PV occlusion by cryoballoon was associated with lower minimum temperature, as well as better success rate of PVI and the long-term outcome in terms of the isolation effect. 3–6 , 11 Due to the anatomical shape of the left atrium and PV ostia, some PVs cannot be completely occluded by cryoballoon. 7 The 31 mm mode of the POLARx™ FIT used in this case series showed better PV occlusion than the 28 mm mode in cases with large left atria and large PVs (e.g.…”

“…The PV potentials and spontaneous firing from all PVs were confirmed using POLARMAP™ at the initiation of cryoablation. For all PVs, before the cryoablation, the seal between the 28 mm and 31 mm modes and venous ostium was assessed with an injection of 50% diluted contrast medium to compare the occlusion grade 11 : grade 4: complete occlusion; grade 3: minimal leakage; grade 2: moderate leakage; and grade 1: severe leakage. Following the detection of occlusion, cryothermal energy was initiated using only the 31 mm mode of POLARx™ FIT; the LSPV was treated for 4 min, while the other PVs were treated for 3 min.…”

Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation–An underappreciated frequent cause of incomplete isolation

“…The assessment of PV occlusion was conducted using ICE and a novel, dielectric imaging‐based occlusion tool (DIOT) integrated with the Kodex mapping system. The workflow of DIOT (version 1.4.8) for PV occlusion assessment has been described previously 6–9 …”

“…The workflow of DIOT (version 1.4.8) for PV occlusion assessment has been described previously. [6][7][8][9] In brief, an electric field is created by driving non-stimulatory cur- sion was assessed pre-ablation as the baseline evaluation, followed by 8-12 mL 0.90% saline injection to confirm PV occlusion status. In the case of partial occlusion, defined as one or more red electrodes, the balloon was repositioned to obtain complete occlusion if possible.…”