Comparison between contrast-guided and pressure-guided ablation using the novel pressure visualization tool for cryoballoon pulmonary vein isolation

TL;DR

This study compares two methods for cryoballoon pulmonary vein isolation and finds that using pressure monitoring reduces contrast use without affecting procedure outcomes.

Contribution

The novel contribution is demonstrating the feasibility of pressure-guided ablation as an alternative to contrast-guided ablation for pulmonary vein isolation.

Findings

Pressure-guided ablation achieved comparable procedural outcomes to contrast-guided ablation.

Pressure-guided ablation significantly reduced contrast use by over 50%.

Procedural time, left atrial dwell time, and fluoroscopy time were similar between the two methods.

Abstract

During cryoballon pulmonary vein isolation (PVI) complete occlusion of the pulmonary vein ostia during the freeze cycles is mandatory. Typically, PV occlusion is assessed by contrast injection under fluoroscopy. Using an update for the Cryo Console it is possible to directly visualize occlusion pressure as an indicator of complete PV occlusion during cryoballoon procedures. In this study, we compared PV pressure monitoring during cryoballoon PVI to a conventional approach regarding procedural outcomes. We retrospectively analysed the procedural data of 50 patients (25 patients with pressure-guided PVI and 25 patients with contrast-guided PVI) treated with cryoballoon PVI in our centre. Complete PV occlusion in the pressure-guided group was defined as an abrupt change in the pressure waveform with a loss of the a-wave after advancing the cryoballoon to the PV ostium. We observed comparable results regarding procedural time, left atrial dwell time or fluoroscopy time when comparing the pressure guided to our conventional approach. Moreover, there were no differences regarding acute procedural effectivity or freeze cycle characteristics. As expected, a significant reduction of contrast use was achieved in the pressure measurement group (10.4 vs. 25.5 ml, p < 0.0001). Monitoring complete PV occlusion by visualizing the occlusion pressure is feasible. Acute procedural outcome was comparable to our standard approach using contrast injection to verify complete PV occlusion. Most importantly, a significant reduction in contrast use could be achieved which has to be confirmed in larger patient cohorts.

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