Cryoballoon Pressure Waveform Change during Balloon Inflation is not a Reliable Predictor of Adequate Pulmonary Vein Occlusion

Safavi‐Naeini, Payam; Shanoon, Farah; Nazeri, Alireza; Rasekh, Abdi; Saeed, Mohammad; Razavi, Mehdi; Massumi, Ali

doi:10.1111/pace.12491

Cited by 13 publications

(15 citation statements)

References 16 publications

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“…Some other techniques were tested to reduce or avoid contrast injection (in case of renal insufficiency, contrast media allergy, radiation exposure etc.) such as intracardiac echocardiography (ICE) 10 and transesophageal echocardiography color flow Doppler (TEE), 11 3D TEE 12 and charting the pressure waveform recordings at the cryoballoon (CB) tip during occlusion 13,14 …”

Section: Discussionmentioning

confidence: 99%

Occlusion tool software for pulmonary vein occlusion verification in atrial fibrillation cryoballoon ablation

Cauti

Solimene²,

Stabile³

et al. 2020

Pacing Clinical Electrophis

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Background Optimal pulmonary vein (PV) occlusion, usually verified with selective contrast injection, is mandatory to obtain an effective PV isolation during cryoballoon (CB) ablation. Aim of the study The purpose of this study was to verify the feasibility and the accuracy of a new dielectric sensing system in assessing PV occlusion during CB ablation in patients with atrial fibrillation (AF). Methods We enrolled 28 consecutive patients with paroxysmal or persistent AF. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octapolar or decapolar mapping catheter (Achieve catheter, Medtronic Inc.) and KODEX‐EPD system (EPD Solutions, a Philips company). The degree of PV occlusion with the inflated Arctic Front Advance Cryoballoon (Medtronic Inc.) was verified using the new “occlusion tool” software module (EPD Solutions, a Philips company) and compared to an angiogram obtained with contrast medium injection in each PV. Results A total of 105 PV CB occlusion were tested. The new occlusion tool software module showed a 91% sensitivity and 76% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 80%, and the negative predictive value was 88.6%. Mean procedure time was 81 ± 17 minutes. Mean fluoroscopy time was 6 ± 2 minutes. No 30‐day complications were observed. Conclusion The new dielectric imaging system was able to assess the degree of PV occlusion during a CB ablation with good sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Occlusion tool software for pulmonary vein occlusion verification in atrial fibrillation cryoballoon ablation

Cauti

Solimene²,

Stabile³

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…Initially, angiography constituted a method of confirming PV occlusion. However, due to the complications of radioiodine contrast, prolonged fluoroscopy times, and the frequent coexistence of chronic kidney disease in patients with AF, various predictors of PV occlusion and electrical isolation have been analyzed [8]. In 2009, Siklody et al introduced the transesophageal-Doppler-echocardiography (TEE)-guided cryoballoon apposition of PV and electrical isolation [4].…”

Section: Discussionmentioning

confidence: 99%

“…The study authors noticed that angiographic complete PV occlusion was detected in 43 of 67 PVs (64%) at the point when there was a change in the waveform from LA to PA. In the remaining 24 PVs, PV occlusion was completed with the adjustment of the cryoballoon under intracardiac echocardiographic guidance [8].…”

Section: Discussionmentioning

confidence: 99%

Pressure-Guided cryoablation of pulmonary veins in atrial fibrillation: A fast and effective strategy

Raizada

Gedela

Shaikh

et al. 2017

Indian Heart Journal

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“…Hence, the PV occlusion assessment is of crucial value in CBA procedure. Currently, pulmonary venography is regarded as the standard criterion, although various alternatives have been proposed to reduce contrast or fluoroscopy use, such as intracardiac echocardiography (ICE) 16 , transesophageal echocardiography (TEE) 17,18 , and change of the pressure waveform recorded at the CB tip during occlusion 19,20 . Also, KODEX-EPD system is equipped with various tools for occlusion assessment 11,[21][22][23] .…”

Section: Occlusion Assessment Toolsmentioning

confidence: 99%

Performance of Two Tools for Pulmonary Vein Occlusion Assessment with a Novel Navigation System in Cryoballoon Ablation Procedure

Niu

Qiao

Zhao

et al. 2022

Preprint

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Background 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% 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 ℃ vs -35.1 + 6.5 ℃, p < 0.001; injection tool: -46.7 + 6.4 ℃ vs -38.3 + 9.2 ℃, p < 0.001) and longer total thaw time (baseline tool: 53.3 + 17.0 s vs 38.2 + 14.9 s, p = 0.003; injection tool: 58.5 + 15.5 s vs 41.7 + 15.2 s, p < 0.001) 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.

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Cryoballoon Pressure Waveform Change during Balloon Inflation is not a Reliable Predictor of Adequate Pulmonary Vein Occlusion

Abstract: The change in pressure waveforms at the distal tip of inflated cryoballoon is not a reliable predictor of complete PV occlusion during cryoballoon ablation.

Cited by 13 publications

References 16 publications

Occlusion tool software for pulmonary vein occlusion verification in atrial fibrillation cryoballoon ablation

Occlusion tool software for pulmonary vein occlusion verification in atrial fibrillation cryoballoon ablation

Pressure-Guided cryoablation of pulmonary veins in atrial fibrillation: A fast and effective strategy

Performance of Two Tools for Pulmonary Vein Occlusion Assessment with a Novel Navigation System in Cryoballoon Ablation Procedure

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