AUTHOR=Rottner Laura , Obergassel Julius , Borof Katrin , My Ilaria , Moser Fabian , Lemoine Marc , Wenzel Jan-Per , Kirchhof Paulus , Ouyang Feifan , Reissmann Bruno , Metzner Andreas , Rillig Andreas 

TITLE=A novel saline-based occlusion tool allows for dye-less cryoballoon-based pulmonary vein isolation and fluoroscopy reduction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1156500

DOI=10.3389/fcvm.2023.1156500

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Cryoballoon (CB)- based pulmonary vein isolation (PVI) remains guided by fluoroscopy and dye. The novel saline injection-based occlusion tool allows for pulmonary vein (PV)-occlusion assessment without the need for dye injection.</p></sec><sec><title>Aim</title><p>To compare KODEX-EPD guided CB-PVI using the novel saline injection-based workflow with conventional cryoablation for acute efficacy, fluoroscopy exposure and dye volume.</p></sec><sec><title>Methods</title><p>Consecutive atrial fibrillation (AF)- patients undergoing CB-PVI in conjunction with KODEX-EPD (Cryo<sup>EPD</sup> group) were analyzed. Patients undergoing conventional CB-PVI (Cryo group) in the same time period acted as controls.</p></sec><sec><title>Results</title><p>One hundred forty patients [91/140 (65%) persistent AF] were studied. Seventy patients underwent Cryo<sup>EPD</sup> procedures [64 ± 13 years, 21 (30%) female] and seventy patients underwent Cryo procedures [68 ± 10 years, 27 (39%) female].</p><p>A total of 560 PVs were identified and successfully isolated. Mean procedure time was 66 ± 15 min for the Cryo<sup>EPD</sup> group, and 65 ± 19 min for the Cryo group (<italic>p</italic> = 0.3). Fluoroscopy time (Cryo<sup>EPD</sup> 6 ± 4 min; Cryo 13 ± 6 min, <italic>p</italic> &lt; 0.001) and dose area product (Cryo<sup>EPD</sup> 193 [111; 297] cGycm<sup>2</sup>; Cryo 381 [268; 614] cGycm<sup>2</sup>, <italic>p</italic> &lt; 0.001) were lower in patients undergoing Cryo<sup>EPD</sup> compared with Cryo procedures. No dye was needed in the Cryo<sup>EPD</sup> group while 53 ± 18 ml dye per patient were administered for the Cryo group (<italic>p</italic> &lt; 0.001). The overall complication rate was comparable between both groups (<italic>p</italic> = 0.5).</p></sec><sec><title>Conclusion</title><p>KODEX-EPD guided AF-ablation enables dye-free CB-based PVI with reduced fluoroscopy exposure when compared to conventional CB-ablation, without differences in acute procedural outcomes or procedure duration.</p></sec>