Novel dyeless and fluoro-less approach to cryoballoon pulmonary vein occlusion assessment

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Boaz AvitallNicolas Coulombe

Abstract

Pulmonary vein (PV) occlusion is essential for PV isolation (PVI) using the cryoballoon. Currently occlusion is arbitrarily determined using fluoroscopy and contrast media. This study aimed to create an objective measure without utilizing excessive fluoroscopy and using no contrast media. To ensure PV occlusion without fluoroscopy and contrast dye. In 4 in vivo hearts 113 PV occlusions were tested with a 50% cold dye saline mix at 4°C. Occlusions were rated Good, Fair, and Poor by dye dissipation seen via fluoroscopy and correlated to temperature profiles recorded concurrently. Using these temperature profiles and no dye, cryoablations were placed in 12 additional hearts (56 unique veins, 126 occlusions). Two 180-second cryoablation applications were placed per vein with occlusion testing in between. PVI was defined by electrophysiology mapping, gross pathology, and histology after ≥4 weeks recovery. Dye results were as follows: With Good, Fair, and Poor the maximal postinjection PV temperature dropped (ΔT) by 6.2 ± 4.2°C, 5.1 ± 3.7°C, and 2.4 ± 2.0°C. At 5 seconds post nadir temperature, injection temperature recovered 18% ± 14%, 36% ± 23%, and 50% ± 33%. Console thaw time to 0°C was 11.5 ± 4.8 seconds, 8.5 ± 2.1 seconds, and ...Continue Reading

Citations

Aug 6, 2019·Journal of Cardiovascular Electrophysiology·Boaz AvitallTimothy G Laske
Jun 15, 2021·Frontiers in Cardiovascular Medicine·Michael KühneChristian Sticherling

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