Cryoballoon ablation for atrial fibrillation without the use of a contrast medium: a combination of the intracardiac echocardiography and pressure wave monitoring guided approach

Abstract Funding Acknowledgements Type of funding sources: None. Background. Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied. Purpose. The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF. Methods. 15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter. Results. A total of 72 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 76.5% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 80.3%, and the negative predictive value was 88.6%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed. Conclusion. This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation. Abstract Figure. Occlusion tool software 1.4.6 vs 1.4.7

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CRYOBALLOON ABLATION OF PAROXYSMAL ATRIAL FIBRILLATION GUIDED BY INTRACARDIAC ECHOCARDIOGRAPHY: PREDICTION OF ACUTE SUCCESS BY A NON-FLUOROSCOPIC IMAGING TECHNIQUE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)60051-4 ◽

2010 ◽

Vol 55 (10) ◽

pp. A5.E50

Author(s):

Georg Nö;lker ◽

Johannes Heintze ◽

Klaus J. Gutleben ◽

Bogdan G. Muntean ◽

Ameera Yalda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Imaging Technique ◽

Intracardiac Echocardiography ◽

Cryoballoon Ablation ◽

Fluoroscopic Imaging ◽

Acute Success

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Intracardiac Echocardiography Improves Procedural Efficiency During Cryoballoon Ablation for Atrial Fibrillation: A Pilot Study

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2010.01796.x ◽

2010 ◽

Vol 21 (11) ◽

pp. 1202-1207 ◽

Cited By ~ 38

Author(s):

MARTIN SCHMIDT ◽

MARCOS DACCARETT ◽

HARALD MARSCHANG ◽

GUIDO RITSCHER ◽

OLIVER TURSCHNER ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pilot Study ◽

Intracardiac Echocardiography ◽

Cryoballoon Ablation

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Accuracy comparison of the new and previous Kodex occlusion tool software versions to assess pulmonary vein occlusion in atrial fibrillation cryoablation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0386 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

F M Cauti ◽

P Rossi ◽

L Iaia ◽

M Polselli ◽

A Pecere ◽

...

Keyword(s):

Atrial Fibrillation ◽

Positive Predictive Value ◽

Contrast Medium ◽

Negative Predictive Value ◽

Pulmonary Vein ◽

Predictive Value ◽

First Generation ◽

Second Generation ◽

Cryoballoon Ablation ◽

Contrast Medium Injection

Abstract Background Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied. Purpose The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF. Methods 15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter. Results A total of 74 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 74.2% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 82.9%, and the negative predictive value was 85.2%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed. Conclusion This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation. FUNDunding Acknowledgement Type of funding sources: None.

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Correction to: Differences in prothrombotic response between the uninterrupted and interrupted apixaban therapies in patients undergoing cryoballoon ablation for paroxysmal atrial fibrillation: a randomized controlled study

Heart and Vessels ◽

10.1007/s00380-019-01424-y ◽

2019 ◽

Vol 34 (9) ◽

pp. 1542-1542

Author(s):

Monami Ando ◽

Yasuya Inden ◽

Yukihiko Yoshida ◽

Akinori Sairaku ◽

Satoshi Yanagisawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Randomized Controlled Study ◽

Controlled Study ◽

Cryoballoon Ablation ◽

Randomized Controlled

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Clinical Applications of Laser Technology: Laser Balloon Ablation in the Management of Atrial Fibrillation

Micromachines ◽

10.3390/mi12020188 ◽

2021 ◽

Vol 12 (2) ◽

pp. 188

Author(s):

Jamario R. Skeete ◽

Jeanne M. Du-Fay-de-Lavallaz ◽

David Kenigsberg ◽

Carlos Macias ◽

Jeffrey R. Winterfield ◽

...

Keyword(s):

Atrial Fibrillation ◽

Laser Energy ◽

Clinical Applications ◽

Ablation Techniques ◽

Cryoballoon Ablation ◽

Laser Technology ◽

Balloon Ablation ◽

Established Role ◽

Laser Balloon Ablation ◽

Laser Balloon

Catheter-based ablation techniques have a well-established role in atrial fibrillation (AF) management. The prevalence and impact of AF is increasing globally, thus mandating an emphasis on improving ablation techniques through innovation. One key area of ongoing evolution in this field is the use of laser energy to perform pulmonary vein isolation during AF catheter ablation. While laser use is not as widespread as other ablation techniques, such as radiofrequency ablation and cryoballoon ablation, advancements in product design and procedural protocols have demonstrated laser balloon ablation to be equally safe and effective compared to these other modalities. Additionally, strategies to improve procedural efficiency and decrease radiation exposure through low fluoroscopy protocols make this technology an increasingly promising and exciting option.

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Technical and procedural comparison of two different cryoballoon ablation systems in patients with atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-01035-6 ◽

2021 ◽

Author(s):

Sven Knecht ◽

Christian Sticherling ◽

Laurent Roten ◽

Patrick Badertscher ◽

Laurève Chollet ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial Volume ◽

Median Number ◽

Volume Index ◽

Group Differences ◽

Cryoballoon Ablation ◽

Left Atrial Volume Index ◽

Ice Cap ◽

Total Procedure Time ◽

Catheter Design

Abstract Purpose The aim was to report procedural and technical differences of a novel cryoballoon (NCB) ablation catheter for pulmonary vein isolation (PVI) compared to the standard cryoballoon (SCB) catheter. Methods Consecutive patients with atrial fibrillation (AF) undergoing PVI using the NCB and the SCB were included. Procedural parameters, technical differences, acute efficacy, and safety are reported. Results Eighty patients (age 66 ± 10 years, ejection fraction 57 ± 10%, left atrial volume index 40 ± 6 ml/m2) were studied. With the NCB, 156 of 158 PVs (99%) were isolated compared to isolation of 159 of 159 PVs (100%) with the SCB. The median number of freezes in the NCB and the SCB group was 6 (IQR 5–8) and 5 (IQR 4–7), respectively (p = 0.051), with 73% and 71% of the PVs isolated with a single freeze, respectively. Nadir temperature and temperature at isolation were − 59 ± 6 °C and − 45 ± 17 °C in the NCB group and − 46 ± 7 °C and − 32 ± 23 °C in the SCB group, respectively (both p < 0.001) with no difference in time to isolation (TTI). Procedural differences were observed for the total procedure time (84 ± 29 min in the NCB group and 65 ± 17 min in the SCB group, p = 0.003). There was a peri-procedural stroke in one patient in the NCB group. Differences in catheter design were observed that may account for the differences in temperature recordings and ice cap formation. Conclusions Acute efficacy and TTI were similar with the NCB compared to the SCB. Measured temperatures were lower with the NCB, most likely due to differences in catheter design.

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