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

• DOI: 10.3389/fcvm.2023.1156500
• Publication Date: 2023-03-24T06:13:21Z
• Authors: Laura Rottner; Julius Obergassel; Katrin Borof; Ilaria My; Fabian Moser; Marc Lemoine; Jan-Per Wenzel; Paulus Kirchhof; Feifan Ouyang; Bruno Reissmann; Andreas Metzner; Andreas Rillig
• Keywords: saline injection; RC666-701; occlusion tool; dielectric imaging; Diseases of the circulatory (Cardiovascular) system; atrial fibrillation; dye-less cryoballoon-based ablation; Cardiovascular Medicine; fluoroscopy reduction fluoroscopy reduction with saline injection atrial fibrillation; 9.4.4 - Catheter Ablation of Arrhythmias; 3. Good health

BackgroundCryoballoon (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.AimTo compare KODEX-EPD guided CB-PVI using the novel saline injection-based workflow with conventional cryoablation for acute efficacy, fluoroscopy exposure and dye volume.MethodsConsecutive atrial fibrillation (AF)- patients undergoing CB-PVI in conjunction with KODEX-EPD (CryoEPD group) were analyzed. Patients undergoing conventional CB-PVI (Cryo group) in the same time period acted as controls.ResultsOne hundred forty patients [91/140 (65%) persistent AF] were studied. Seventy patients underwent CryoEPD procedures [64 ± 13 years, 21 (30%) female] and seventy patients underwent Cryo procedures [68 ± 10 years, 27 (39%) female].A total of 560 PVs were identified and successfully isolated. Mean procedure time was 66 ± 15 min for the CryoEPD group, and 65 ± 19 min for the Cryo group (p = 0.3). Fluoroscopy time (CryoEPD 6 ± 4 min; Cryo 13 ± 6 min, p < 0.001) and dose area product (CryoEPD 193 [111; 297] cGycm2; Cryo 381 [268; 614] cGycm2, p < 0.001) were lower in patients undergoing CryoEPD compared with Cryo procedures. No dye was needed in the CryoEPD group while 53 ± 18 ml dye per patient were administered for the Cryo group (p < 0.001). The overall complication rate was comparable between both groups (p = 0.5).ConclusionKODEX-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.