Wide-Band Dielectric Imaging and the Novel Cryoballoon-Occlusion Tool to Guide Cryoballoon-Based Pulmonary Vein Isolation

Abstract Background Cryoballoon (CB)-based pulmonary vein isolation (PVI) currently requires to verify occlusion of each pulmonary vein (PV) using fluoroscopy and dye injection. Objective The current study evaluated whether the novel CB-occlusion tool integrated into the wide-band dielectric imaging system KODEX-EPD reliably verifies occlusion of PV according to a novel dye-injection based algorithm. Methods Consecutive patients suffering from symptomatic atrial fibrillation (AF) underwent CB-based PVI using the KODEX-EPD and the novel occlusion-tool (group I). To confirm accurate display of the PVs, selective PV-angiography was performed in the first half of the patients of group I (group Ia) in addition to a three-dimensional left atrial (LA) map using a spiral mapping catheter (Achieve, SMC1, Medtronic, MN, USA). PV-angiographies were waived for the following patients (group Ib). Procedural duration and radiation exposure were compared to a control group of patients undergoing conventional CB-based PVI. Results CB-based PVI was successful in 50/50 patients of group I (mean age 63±11 years, 18 paroxysmal (36%)) and 25/25 patients of group II (66±10 years, 9 paroxysmal (60%)). Concordance of PV-occlusion as assessed by either PV-occlusion-angiography or KODEX-EPD, was documented in 237/272 (87%) occlusion-analyses among 198 PVs (95% for left superior PV, 93% for left inferior PV, 86% for right inferior PV and 77% for right superior PV). In the final evaluation phase (group Ib) LA fluoroscopy times and dose area products were comparable to the conventional CB-ablation group (10.5±5 vs 8.8±4 minutes (p=0.23) and 403±425 vs 321±202 cGycm2 (p=0.44), whereas the amount of dye could be significantly reduced (group Ib: 31±10 ml vs group II: 70±20 ml, p<0.0001). Conclusion The novel KODEX-EPD PV-occlusion tool allows for accurate PV-occlusion assessment in the majority of PVs and a high acute success rate. The system has the potential to reduce dye and radiation exposure. This should be evaluated in controlled clinical trials. FUNDunding Acknowledgement Type of funding sources: None.

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58-04: Initial results of pulmonary vein isolation using the novel third-generation cryoballoon

EP Europace ◽

10.1093/europace/18.suppl_1.i169b ◽

2016 ◽

Vol 18 (suppl_1) ◽

pp. i169-i169 ◽

Cited By ~ 14

Author(s):

Alexander Fürnkranz ◽

Bordignon Stefano ◽

Daniela Dugo ◽

Perotta Laura ◽

Fabrizio Bologna ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Third Generation ◽

The Novel ◽

Initial Results

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P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽

10.1093/europace/euaa162.203 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A P Martin ◽

M Fowler ◽

N Lever

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Pulmonary Veins ◽

Posterior Wall ◽

The Novel ◽

Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated. Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

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Short tip–more function? Atrial fibrillation ablation using the novel third-generation cryoballoon in resected pulmonary vein

International Journal of Arrhythmia ◽

10.1186/s42444-019-0006-z ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Shaojie Chen ◽

Boris Schmidt ◽

Stefano Bordignon ◽

Fabrizio Bologna ◽

K. R. Julian Chun

Keyword(s):

Atrial Fibrillation ◽

Real Time ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Pulmonary Veins ◽

Cryoballoon Ablation ◽

Third Generation ◽

The Novel ◽

Case Presentation ◽

Pulmonary Surgery

Abstract Background Cryoballoon ablation is an established procedure for atrial fibrillation (AF). Patients who had previous pulmonary surgery undergoing pulmonary vein isolation (PVI) were seldom reported. Case presentation We describe an AF ablation using the novel short-tip third-generation cryoballoon in a patient with resected pulmonary vein. All pulmonary veins were successfully isolated without complication. The short-tip third-generation cryoballoon shows advantageous profile in PVI for AF patients with previous pulmonary surgery. Conclusions This report indicates that for AF patient who had previous resected PV surgery, the short-tip CB 3 provides an ideal device option for real-time PVI.

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Novel Wide-Band Dielectric Imaging System and Occlusion Tool to Guide Cryoballoon-Based Pulmonary Vein Isolation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.009219 ◽

2020 ◽

Vol 13 (12) ◽

Author(s):

Andreas Rillig ◽

Laura Rottner ◽

Milena Nodorp ◽

Tina Lin ◽

Jessica Weimann ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Imaging System ◽

Wide Band

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P835The force awakens: one year clinical outcome after pulmonary vein isolation using the novel ThermoCool SmartTouch Surround Flow catheter

EP Europace ◽

10.1093/europace/euy015.439 ◽

2018 ◽

Vol 20 (suppl_1) ◽

pp. i154-i155

Author(s):

C Sohns ◽

L Rottner ◽

B Reissmann ◽

C H Heeger ◽

C H Lemes ◽

...

Keyword(s):

Clinical Outcome ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

The Novel ◽

One Year

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Esophageal temperature change and esophageal thermal lesions after pulmonary vein isolation using the novel endoscopic ablation system

Heart Rhythm ◽

10.1016/j.hrthm.2011.01.022 ◽

2011 ◽

Vol 8 (6) ◽

pp. 815-820 ◽

Cited By ~ 30

Author(s):

Andreas Metzner ◽

Boris Schmidt ◽

Alexander Fuernkranz ◽

Erik Wissner ◽

Roland Richard Tilz ◽

...

Keyword(s):

Pulmonary Vein ◽

Temperature Change ◽

Pulmonary Vein Isolation ◽

The Novel ◽

Esophageal Temperature ◽

Thermal Lesions ◽

Endoscopic Ablation

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Single-Sweep Pulmonary Vein Isolation using the new third-generation laser balloon -- Evolution in ablation style using endoscopic ablation system

10.22541/au.162223100.04469413/v1 ◽

2021 ◽

Author(s):

Shota Tohoku ◽

Stefano Bordignon ◽

Luca Trolese ◽

Simone Zanchi ◽

Lorenzo Bianchini ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

The Novel ◽

Visually Guided ◽

Phrenic Nerve Palsy ◽

Endoscopic Ablation ◽

First Pass ◽

The Mean ◽

Ischemic Attack ◽

Total Procedure

Background: The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The novel X3 EAS is now equipped with a contiguous circumferential ablation mode (RAPID mode). Aim: To determine the feasibility of single-sweep ablation using X3. Methods: Consecutive patients who underwent AF ablation using X3 were enrolled. We assessed the acute procedural data focusing on “Single-sweep PVI” defined as PVI with a single energy application using RAPID mode to complete the circular lesion set, and on “first-pass isolation” defined as successful visually guided PVI after initial circular lesion set. Results: One-hundred AF patients (56% male, age 68±10 years, 66% paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were isolated with X3. Single-sweep isolation and first-pass-isolation were achieved in 214 PVs (56%) and in 362 PVs (95%), respectively. Single-sweep isolation rates varied across PVs with higher rates at the superior PVs (61.2% vs. inferior PVs:49.5%, P=0.0239) and at PVs with maximal ostial diameter <24mm (57.6% vs. >24mm: 36.8%, P=0.0151). The mean total procedure and fluoroscopy times were 43.0±10 and 4.0±2 mins, respectively. In none of the patients an acute thromboembolic event (stroke or transient ischemic attack) or a pericardial effusion/tamponade occurred. A single transient phrenic nerve palsy was observed. Conclusion: The new X3 EAS allows for single-sweep PVI in 56% of PVs. The new RAPID ablation mode leads to an improved rate of first-pass isolation associated with very short procedure times without compromising safety.

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News from the Cold Chamber: Clinical Experiences of POLARx versus Arctic Front Advance for Single-Shot Pulmonary Vein Isolation

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd9010016 ◽

2022 ◽

Vol 9 (1) ◽

pp. 16

Author(s):

Denise Guckel ◽

Philipp Lucas ◽

Khuraman Isgandarova ◽

Mustapha El Hamriti ◽

Leonard Bergau ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Pulmonary Veins ◽

Major Complication ◽

Single Shot ◽

The Novel ◽

Clinical Experiences ◽

Front Advance ◽

Arctic Front ◽

Cold Chamber

Cryoballoon (CB)-guided pulmonary vein isolation (PVI) represents a cornerstone in the treatment of atrial fibrillation (AF). Recently, a novel balloon-guided single shot device (POLARx, Boston Scientific) was designed. Our study aimed to compare the efficacy, safety and characteristics of the novel CB system with the established one (Arctic Front Advance (Pro), AFA, Medtronic). A total number of 596 patients undergoing CB-guided ablation for AF were included. 65 patients (65.0 ± 11.6, 31% female) undergoing PVI with the POLARx were compared to a cohort of 531 consecutive patients (63.0 ± 27.9, 25% female) treated with AFA. Acute PVI was achieved in all patients (n = 596, 100%). Total procedure duration (POLARx 113.3 ± 23.2 min, AFA 100.9 ± 21.3 min; p < 0.001) and fluoroscopy time (POLARx 10.5 ± 5.9 min, AFA 4.8 ± 3.6 min; p < 0.001) were significantly longer in the POLARx group. The POLARx balloon achieved significantly lower nadir temperatures (POLARx −57.7 ± 0.9 °C, AFA −45.1 ± 2.6 °C; p < 0.001) and a significantly higher percentage of pulmonary veins successfully isolated with the first freeze (p = 0.027 *). One major complication occurred in the POLARx (2%) and three (1%) in the AFA group. Both ablation systems are comparably safe and effective. AF ablation utilizing the POLARx system is associated with longer procedure and fluoroscopy times as well as lower nadir temperatures.

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