AUTHOR=Rottner Laura , Obergassel Julius , My Ilaria , Kirchhof Paulus , Ouyang Feifan , Reissmann Bruno , Metzner Andreas , Rillig Andreas 

TITLE=Cryoballoon ablation guided by a novel wide-band dielectric imaging system

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.967341

DOI=10.3389/fcvm.2022.967341

ISSN=2297-055X

ABSTRACT=Background: A novel occlusion tool was recently introduced for the KODEX-EPD (Philips, Netherlands) dielectric cardiac imaging system. It displays the level of pulmonary vein (PV) occlusion during cryoballoon (CB)-based PV-isolation (PVI) for the treatment of atrial fibrillation (AF). 
Aim: To investigate feasibility, acute efficacy, periprocedural safety, and procedural parameters of CB-based PVI guided by KODEX-EPD using different software versions. 
Methods and Results: 173 patients (60/173 (35%) paroxysmal AF, 64±12 years, 66/173 (38%) female), underwent CB-based PVI guided by KODEX-EPD between 08/2019 and 10/2021. Acute PVI was achieved in all patients. Total fluoroscopy time and dye volume was 13.9 [10.6-19.4] min. and 47.5 [20.0-70.0] ml. Periprocedural complications occurred in 3/173 (2%) patients. As part of the continued development program, different software versions were used, including 1.4.6 in 38/173 (22%); 1.4.6a in 33/173 (19%); 1.4.7 in 41/173 (24%) and 1.4.8 in 61/173 (35%) patients. Outcomes were compared between software versions using univariate analysis. Sensitivity analyses were performed to account for identified confounders. Median fluoroscopy time decreased by 6.4 minutes (37.3%) and median volume of dye decreased by 32.5 ml (52%) from version 1.4.6 to 1.4.8. Software version was a significant predictor of fluoroscopy time and dye volume, while reductions of procedure duration and dose area product were observed but mainly explained via confounders. 
Conclusion: CB-based PVI guided by KODEX-EPD is feasible and safe. Progressive software improvements appear to be associated with lower fluoroscopy duration and dye use. Further studies are needed to evaluate the advantage of KODEX-EPD-guided compared to conventional CB-based PVI.