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

Abstract

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.

Catheter Ablation in Complex Atrial Arrhythmias: Pilot Study Evaluating a 3D Wide-Band Dielectric Imaging System

“…Interestingly, the specificity of the occlusion tool analyzed for each PV shows a lower value for LIPV (60%) as compared to the remaining PVs (LSPV 100%, RIPV 90%, RSPV 100%). Cauti et al has previously shown that there is a predicted variation in specificity for each PV (27). Our results confirm the hypothesis that a variation might exist for the accuracy of the occlusion tool in the present version when approaching some veins such as the LIPV.…”

“…The first step of our strategy consisted of a straightforward CBA based PVI which was guided by using the occlusion tool software module provided by the new imaging system in addition to conventional PV angiography. We were able to confirm the results of Cauti et al (27) and Rillig et al (17). The sensitivity and specificity of the occlusion tool were high.…”

Novel Wide-Band Dielectric Imaging System Guided Lead Deployment for His Bundle Pacing: A Feasibility Study

“…Those features can improve the procedural efficiency. The previous studies showed the feasibility of using the KODEX-EPD system in radiofrequency or cryoballoon ablation in clinical practice (14,(18)(19)(20).…”

Potential advantages of the KODEX‐EPD system as the fourth 3D mapping system for atrial fibrillation ablation

“…In the event of a partial occlusion, the effects of balloon maneuvering to obtain better and complete occlusion are shown in real time without the need for several checks and the use of multiple dye injections and angiograms. Cauti et al 12 tested the accuracy of the software module in 105 PVs during cryoballoon ablation by verifying with contrast medium injection and reported good sensitivity of 91% and specificity of 76%. Cryoballoon visualization: Direct visualization of the cryoballoon catheter itself would allow maneuvering for complete occlusion while further reducing fluoroscopy time, contrast injections, and, potentially, PV stenosis.…”