Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy.
Arrhythmology Unit, Clinica Montevergine, Mercogliano, AV, Italy.
Pacing Clin Electrophysiol. 2021 Jan;44(1):63-70. doi: 10.1111/pace.14130. Epub 2020 Dec 1.
Optimal pulmonary vein (PV) occlusion, usually verified with selective contrast injection, is mandatory to obtain an effective PV isolation during cryoballoon (CB) ablation.
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).
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.
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.
The new dielectric imaging system was able to assess the degree of PV occlusion during a CB ablation with good sensitivity and specificity.
为了在冷冻球囊（CB）消融过程中实现有效的肺静脉（PV）隔离，通常需要通过选择性对比注射来验证最佳的 PV 闭塞。
本研究旨在验证一种新的介电传感系统在评估房颤（AF）患者 CB 消融过程中 PV 闭塞的可行性和准确性。
我们纳入了 28 例阵发性或持续性 AF 患者。经房间隔穿刺后，使用八极或十极标测导管（Achieve 导管，美敦力公司）和 KODEX-EPD 系统（EPD Solutions，飞利浦公司）对左心房和 PV 进行详细的图像重建。使用新的“闭塞工具”软件模块（EPD Solutions，飞利浦公司）验证膨胀的北极前沿冷冻球囊（美敦力公司）对 PV 的闭塞程度，并与在每个 PV 中使用造影剂注射获得的血管造影进行比较。
共检测了 105 例 PV CB 闭塞。新的闭塞工具软件模块在评估与造影剂注射验证的完全 PV 闭塞方面具有 91%的灵敏度和 76%的特异性。阳性预测值为 80%，阴性预测值为 88.6%。平均手术时间为 81±17 分钟。平均透视时间为 6±2 分钟。未观察到 30 天并发症。
新的介电成像系统能够在 CB 消融过程中评估 PV 闭塞程度，具有良好的灵敏度和特异性。
