Key result
Pressure-guided cryoballoon pulmonary vein isolation significantly reduced contrast agent use compared to a contrast-guided approach (10.4 vs. 25.5 ml, p<0.0001) while achieving 100% acute isolation.
Why the study?
A novel Cryo Console update enables direct visualization of occlusion pressure to indicate pulmonary vein occlusion, but procedural outcomes compared to conventional contrast injection were unknown.
Does pressure-guided cryoballoon PVI reduce contrast use and maintain procedural efficacy compared to contrast-guided PVI in patients undergoing de novo PVI?
Cohort (n=50)
No
Does pressure-guided cryoballoon PVI reduce contrast use and maintain procedural efficacy compared to contrast-guided PVI in patients undergoing de novo PVI?
Pressure-guided cryoballoon pulmonary vein isolation is feasible, maintains acute procedural efficacy, and significantly reduces contrast use compared to the conventional contrast-guided approach.
Pressure monitoring yields comparable acute PVI outcomes with less contrast; leaves open durability and safety benefits in prospective trials.
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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Bengel et al. (2025) conducted a cohort in Atrial fibrillation (n=50). Pressure-guided cryoballoon pulmonary vein isolation vs. Contrast-guided cryoballoon pulmonary vein isolation was evaluated on Contrast agent use (ml) (p=<0.0001). Pressure-guided cryoballoon pulmonary vein isolation significantly reduced contrast agent use compared to a contrast-guided approach (10.4 vs. 25.5 ml, p<0.0001) while achieving 100% acute isolation.
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